Sustainable Solidarity Under Scarcity: A Philosophical and Political Analysis of Veranderen om te behouden (2026–2036)
Abstract Voor de hervorming van het Belgische ziekenhuislandschap: Veranderen om te behouden (2026–2036) proposes a fundamental reorganisation of Belgian hospital care. It differentiates hospital sites by function, concentrates acute and complex care, expands day care and intermediate care, centralises emergency triage, and seeks closer coordination between hospitals, primary care and community services. The report presents this programme through the Quintuple Aim, integrated people-centred care, positive health, solidarity, equity, patient empowerment and professional wellbeing. Its normative centre, however, is more specific than this plural vocabulary suggests. The governing principle is sustainable solidarity under conditions of scarcity: universal access to good care should be preserved, but preserving it requires the concentration of scarce personnel, expertise and infrastructure. The report therefore gives priority to system-level quality and workforce sustainability over ...