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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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The net borrowing of the Belgian Government quadrupled in absolute values
between 2008 and 2009. As a percentage of GDP, Belgium's net borrowing level
was better than the average for the EU27 (27 Member States at January 2007)
in the period 2005–2011. However, it could not maintain this position in 2012
(Eurostat, 2013c). In view of these economic conditions, the federal government
introduced an economic stimulus plan in the middle of 2012 (Federal Planning
Bureau, 2013). In 2013, a social agreement was established for the non-profitmaking
sector in Belgium. This agreement foresaw €40 million earmarked towards
financing the costs of 800 additional full-time equivalent positions in the health
care sector; other actions related to the health care sector are described in section 3.
At the household level, price index data show that inflation has not been as
high in health care (i.e. cost of health care services) as in many other sectors in
Belgium. Only communication services have had a lower inflation in the period
from 2003 to 2013 (Eurostat, 2013d).
2. Health system pressures prior to the crisis
2.1 Demand-side pressures
An underlying source of pressure for the health care sector not directly linked
to the financial crisis has been the increasing population (Table 1.1). Belgium's
population has increased by 6% over 10 years (2003–2012). The composition
of the population in terms of age has not changed markedly throughout the
years. Since 2003, approximately 20% of the population is under 18 years of
age, 62% is between 19 and 64 years and approximately 18% is 65 years and
older (Statbel, 2013). Within the group of people aged 65 years and older,
however, the proportion of people older than 80 increased from 23.7% in 2003
to 29.8% in 2012, demonstrating the rapidly growing segment of the oldest part
of the population (Statbel, 2013). An ageing population puts pressure on the
health system. The same applies to the share of people at risk of poverty, which
is currently almost 25% in Belgium after social transfers. Compared with similar
European countries, this is a relatively high rate of poverty risk. The crisis has had
a visible impact on the proportion of people at risk of poverty, which started to
increase in 2009 after a period of decrease before the economic crisis.
2.2 Supply-side pressures
Health system financing
Another pressure on the health system is sustainable financing. On the one
hand, Belgium has always attached high importance to health care; on the other
hand, the health care system relies heavily on social security contributions for
financing. In 2013, government spending on health care amounted to 16% of