Belgium hospital reform to include exemptions for Walloon facilities, no forced closures

Belgian health ministers have reached a significant agreement on the core principles of a major hospital reform, aiming to reorganize the country's healthcare landscape. The Interministerial Conference (Cim) Santé validated the reform's main tenets, which include more flexible requirements for Walloon hospitals and provisions for rural areas, ensuring no site is forced to close. This reform addresses the shared recognition that the current Belgian hospital system is not adequately adapted to present-day needs.

The reform acknowledges increasing complexity in care, a rise in chronic conditions, a decrease in traditional hospitalizations, and an increase in day hospitalizations. It also confronts the issue of too many institutions attempting to offer all services with insufficient staff, alongside significant financial difficulties faced by some hospitals. Experts proposed the reform in December 2025 to rationalize the system, and feedback, particularly from the Walloon health agency (Aviq), led to amendments to prevent the creation of healthcare deserts in certain regions.

Under the new structure, hospital sites will be reorganized into four categories. The primary category will be the regional general hospital (HGR), requiring at least 240 beds (180 acute) by January 2037, with an interim target of 200 beds (150 acute) by 2031. Flexibility is introduced by including ambulatory surgery beds in the count, and criteria will be re-evaluated in 2031. University hospitals (CHU) will function as HGRs with added complex care and academic missions.

Other categories include the day hospital (CHJ), which will handle specific surgical, oncological, geriatric, and psychiatric care, and the intermediate care hospital (HSI) for rehabilitation and palliative care. Each CHJ or HSI must be affiliated with an HGR to form hospital ensembles. The precise responsibilities for each structure are still to be detailed by the ministers, with current general hospitals not meeting HGR criteria needing to expand or adapt.