Like most developed countries, Belgium is faced with a rate of growth in health spending which exceeds not only the increase in GDP but also exceeds the rate of growth of most other public outlays, be it direct social spending or not. Analysis of the growth in public spending on health over the last decade reveals that it consists very largely of elements which cannot be trimmed. The rise in the cost of living, new technologies, new medicines, the growing assertiveness of patients and the ageing population are all growth factors upon which managers and politicians have only limited impact. The heterogeneous nature of medical practice, often presented as a waste of resources, is, in part, linked to the very nature of medicine, which is still an art, not an exact science. Whilst all malfunction and fraud must be avoided, even if these were totally removed, this would still not keep the rate of growth of health spending within the limit of the legal standard put in place in 1995. If society refuses to finance the sector adequately, and thus run counter to the polls which reveal health to be the top priority for Belgians, it will be necessary to restrict spending. There is a great temptation to opt for means-testing and personal responsibility. The former looks like social progress, the latter is consistent with the promotion of individual freedom. However, both present the danger of privatisation and of a two-tier medical service. To preserve our quality, accessible health-care system, it is therefore imperative to restore taxation and social contributions as the preferred methods of financing. It would thus be possible to widen the scope of compulsory insurance.
