Designing the Belgian “To Be” State: Transforming MZG/RHM and Finhosta for Patient-Based Costing, Care-Process Alignment, and DRG Reform
Introduction In Belgium, hospital financing reform should start from the target state to be achieved rather than from the inherited institutional configuration to be incrementally adjusted. That is especially important because the Belgian health system is structurally path-dependent: it combines near-universal compulsory insurance with direct access, predominantly fee-for-service remuneration, and a division of responsibilities between the federal state and the federated entities that was deepened by the sixth State reform. In hospital financing, Belgium already uses All Patient Refined Diagnosis Related Groups (APR-DRG)/Severity of Illness (SOI) information for budget allocation, but not as a true case-based payment system with national cost weights; the current B2 logic of the Budget of Financial Means (BFM) uses national average length of stay by APR-DRG/SOI as a proxy for resource use. At the same time, Belgium has two mandatory hospital datasets with major strategic value: Minima...