Some thoughts on health and healthcare

Introduction The European Health Data Space (EHDS) changes digital health from a national modernization agenda into a binding European interoperability, patient-rights, and secondary-use agenda. The EHDS Regulation establishes a common EU framework for electronic health-data exchange, strengthens individuals’ access to and control over their health data, enables regulated reuse for research and policymaking, and introduces harmonised interoperability and security requirements for EHR systems (European Commission, 2025a). For Belgium, the issue is not whether digital health exists: Belgium already has strong assets, including the eHealth platform, regional data vaults, ePrescription infrastructure, patient portals, Belgian Integrated Health Record (BIHR), BeSafeShare/Be-SafeShare (Belgian Coordination Authority for Secure Standardized Multidisciplinary Health Data Exchange), Fast Healthcare Interoperability Resources (FHIR) implementation work, and the Health Data Agency (HDA). The cen...

Introduction Diagnosis Related Groups (DRGs) are a case-based hospital payment mechanism that converts coded clinical and administrative data into clinically meaningful, resource-relevant groups to determine prospective reimbursement. A well-functioning DRG system must simultaneously (i) classify patients fairly (clinical coherence and resource homogeneity), (ii) price cases credibly (cost accounting and weight setting), (iii) control incentives that can degrade quality or induce volume inflation, and (iv) assure data integrity through governance, auditing, and quality measurement. International experience - including long-standing US Medicare prospective payment - shows that DRGs can improve transparency and managerial efficiency but also create incentives for shorter stays, coding inflation (“upcoding”), and strategic behavior unless counterbalanced by strong expenditure controls, quality monitoring, and anti-fraud capacity. 1. Conceptual foundations DRG systems were developed to def...