Belgium’s prolonged government formation process underscores the challenges of its fragmented political system. While regional governments are advancing their health agendas, the federal level remains unmoving, with implications for healthcare funding and reforms.

In this article, we take you over the latest updates on the federal negotiations as we approach the end of the year, hoping for a Christmas Miracle.

Walloon and Flemish Governments: Already established health priorities

Both the Walloon and Flemish governments have already been formed as of late 2024. The Walloon government between MR and Les Engagés was finalised on 11 July, with Dr. Yves Coppieters (Les Engagés) appointed as the Health Minister. His priorities include strengthening collaboration with general practitioners, reducing administrative burdens for healthcare providers, enhancing ambulatory care, and placing prevention at the heart of health policies, including vaccination and cancer screening. He also emphasises mental health, improving elderly care options, and addressing urgent environmental health issues such as PFAS contamination.

In Flanders, the government was formed in September 2024, following an agreement between the N-VA, Vooruit, and CD&V parties. Caroline Gennez (Vooruit) serves as the Health Minister, with her agenda centering on reducing waitlists for individuals with disabilities by investing over €100 million in 2025, targeting those with the most urgent needs and phasing out partial budgets in favor of full financial support. She aims to improve care access through immediate investments and long-term structural reforms to ensure equitable support for all in need.

Brussels Government: Stuck in Negotiations

The Government of the Brussels-Capital Region remains in negotiation six months after the elections on the 9th of June. Key issues include the Socialist Party’s (PS) veto against forming a coalition with the Flemish nationalist N-VA. Negotiations have begun on the Dutch-speaking side, led by formator Elke Van den Brandt (Groen), but a comprehensive agreement remains elusive.

The ongoing impasse risks delaying policy initiatives in health, including reducing disparities in access to care across Brussels’ diverse communities.

Federal Government: A Waiting Game

As of December 10th, Belgium’s coalition negotiations remain at an impasse. Despite multiple extensions, Bart De Wever has yet to present a viable coalition proposal, as disagreements over budget priorities and reforms continue to stall progress.

Key sticking points include tax policy, with MR resisting new taxes while Vooruit advocates for levies on high earners, alongside the urgent need to address a €20 billion budget deficit. Compounding the challenges are rising defense costs and a missed deadline to finalise healthcare funding for 2025.

When can we expect a new government?

A new Belgian government is unlikely before Christmas. While the King has extended the Formator’s mandate to December 20th, progress remains minimal, with key negotiations stalled and tensions between parties worsening.

What It Means for Federal Health Policy?

The INAMI (National Institute for Health and Disability Insurance) budget, amounting to over 40 billion euros annually (representing 15% of the Belgian state’s budget), is currently in limbo due to the ongoing negotiations for the new government. This budget covers a wide range of health-related expenses, including medical reimbursements, maternity leave, and hospital funding.

While the budget traditionally grows by 2.5% above inflation each year to meet the increasing demands of healthcare, political tensions have stalled agreement on this year’s increase. The MR and N-VA parties advocate for healthcare cost reductions, while Vooruit, Les Engagés, and CD&V push for the standard 2.5% growth.

For now, INAMI’s 2025 budget mirrors 2024 figures, delaying reforms such as telehealth reimbursement adjustments and hospital funding increases.