Organisation

Hospitals

On 1 January 2025, there were 103 hospitals in Belgium, including 78 conventional general hospitals, 7 university hospitals and 18 hospitals with a university character. One hospital may consist of several campuses. In Belgium, on 1 January 2025, there were 189 campuses. General hospitals can be subdivided into three different types: [1]

‘Conventional’ general hospitals  (76%) These hospitals receive patients day and night to provide specialist medical care. To fulfill the notion of general hospital[2], a hospital must have at least 150 accredited beds and must include a service for surgical activities and internal medicine in addition to at least one other discipline such as geriatrics, maternity, paediatrics, neuropsychiatry or rehabilitation. Furthermore, they must include the functions of anaesthesiology, radiology, basic clinical biology activities, a rehabilitation department, basic hospital pharmacy activities and a palliative care role. Finally, a physician must always be present. Some atypical hospitals are also included in this category. Under the sixth state reform, it was decided to transfer jurisdiction over specialized hospitals (which exclusively offer geriatric and/or rehabilitation services) to the federated entities, except for the Foyer Horizon hospital (which only has beds for specialist palliative care (S4), for which jurisdiction remained with the federal government). At the time, some specialist hospitals chose to merge with a ‘conventional’ general hospital. Others preferred to expand their activities, mostly by adding psychiatric services. From a legal standpoint, these hospitals nowadays form part of the general hospitals, though they do not have a surgical or internal medicine department.

University hospitals  (7%) University hospitals offer at least the same services as conventional general hospitals, but they additionally accommodate patients requiring highly specialised treatment. A university hospital also has a mission to train healthcare providers, engage in scientific research, and develop new technologies. They are connected to a university with a medical school that provides a full programme of study.

General hospitals with a university character (17%) These are general hospitals that have been allocated a number of university beds.

Hospital activities

The activities of hospitals are organised into services, hospital functions and care programmes.

Services group together activities that are linked to a specific location within the hospital. A distinction is made between hospitalisation services, where patients reside during their stay in hospital, and medical or medico-technical services, which provide specific services requiring special expertise or equipment. Medical services include transplant centres or centres for burn victims. Medical-technical services include medical imaging services, human genetics centres, radiotherapy services and kidney dialysis centres.

Hospital functions are hospital activities made available to all hospital departments. Several functions are subject to specific standards and controls imposed and carried out by the competent community or region. Accredited functions include the hospital pharmacy, palliative care, intensive care and the emergency department, the hospital’s blood bank, mediation, pain management and the clinical biology lab, amongst others.

Care programmes can be defined as an organisational framework for implementing ‘care pathways’ for a specific target group. They are the result of an arrangement between the hospitalisation services, medical or medico-technical services and functions that are necessary in order to provide quality care.

There are currently various care programmes:

• The care programme for ‘cardiac pathology’
• The care programme for ‘reproductive medicine’
• The oncology care programme, including the specialised care programme for breast cancer and paediatric haemato-oncology
• The care programme for children
• The care programme for geriatric patients
• The care programme for ‘stroke care’.

To find out more about the location of the various hospitals and the services offered, please visit:
https://www.health.belgium.be/nl/gezondheid/organisatie-van-de-gezondheidszorg/delen-van-gezondheidsgegevens/gezondheidszorginstellingen

Types of hospital services

Each service within the hospital must be accredited and meet specific standards, including minimum bed capacity, the required level of activities, technical facilities equipment and the number of providers of medical, paramedical and care services.

Each service is allocated an identification letter signifying the subgroup of patients concerned. In order to provide a better overview, we will group the different types of services according to the nature of the conditions generally treated there.

• Acute beds: are beds intended for admissions of relatively short duration: e.g. beds for surgery (identification letter C), internal medicine (identification letter D), paediatrics (identification letter E), intensive neonatology (identification letter NIC), maternity (identification letter M), treatment of infectious diseases (identification letter L) and of tuberculosis (identification letter B).
• Geriatric beds: are beds for the care of geriatric patients (identification letter G).
• Chronic beds: are beds designated for longer-term hospitalisations or for patients requiring chronic treatment: such as rehabilitation (identification letter S1 for cardiopulmonary pathologies, S2 for locomotor pathologies, S3 for neurological pathologies, S5 for chronic polypathologies and S6 for psychogeriatric pathologies) and beds for palliative care (identification letter S4).
• Psychiatric beds en places: are beds intended for the care of patients with mental disorders, possibly only during the day or at night: such as beds or places for the observation and neuropsychiatric treatment of adults (identification letters A, a1, a2, T and t1) or of children (identification letter K, k1 and k2).

Evolution in the number of accredited hospital beds

Evolution of the number of accredited hospital beds

Since 1995, we have observed a 24% decrease in the number of accredited acute care beds, which is due to the shorter length of stay of patients for certain conditions and treatments. Contrary to this trend within general hospitals, the number of geriatric beds has increased by 30%, while the number of chronic care beds has risen by a significant 371%, and the number of psychiatric beds by 71%. This increase can be partly explained by the mergers of general with specialized hospitals as a result of the sixth state reform in 2014. The number of accredited psychiatric beds and places is also shown. This number is higher than the actual number of available places because some of these beds were taken out of use to finance alternative forms of care e.g. for mobile teams to provide specialised care in the home environment or for the intensification of residential care[4]. In addition, it is possible that in the case of other types of beds, the number of accredited beds is higher than the actual number of available beds due to factors such as staff shortages.

Collaborative links between hospitals

At a time when healthcare is facing increasingly complex challenges, collaborations between hospitals are becoming increasingly crucial. These partnerships, which range from knowledge sharing to joint care initiatives, provide a unique opportunity to increase the quality of patient care and improve efficiency within the sector. This chapter discusses various forms of collaborations between hospitals.

Hospital association

A hospital association is a legally formalised partnership between two or more hospitals. Within that type of association, the hospitals join forces to jointly manage one or more healthcare programmes, hospital services, functions, departments, medical services, medical- technical services or technical services. The association agreement describes in detail what activities will be performed within the association and in which area of care it will take place. The purpose of an association is to make the best use of available resources and avoid duplication of care. This ensures the quality of care while simultaneously optimising the operations and infrastructure of the participating hospitals.

• Example: AZ Klina in Brasschaat forms an association with AZ Voorkempen in Malle to operate a kidney dialysis centre.

• Example: Clinique CHC and Hôpital de La Citadelle located in Liège obtained accreditation for an association in which they jointly operate a service in which a PET scanner has been set up.

Learn more?
Royal Decree further defining the association of hospitals and the particularstandards it must meet

Hospital grouping

A hospital grouping is a recognised long-term partnership between hospitals situated no more than 25 kilometres apart. Within such a grouping, hospitals agree on the division of labour and complementarity in terms of service offerings, disciplines or equipment. The aim of this is to meet the needs of the population more effectively and improve the quality of healthcare.

• Example: The Sint-Jozefskliniek in Izegem and the AZ Groeninge in Kortrijk have been accredited as a hospital group since 12 February 2024.

• Example: The following hospitals obtained hospital group accreditation on 21 March 2024: CHU Helora - Site Jolimont-Lobbes, CHU Helora - Site Constantinople Mons - Warquignies, CHU Helora - Site Nivelles-Tubize, CHU Helora - Hôpital De Mons.

Learn more?
Royal Decree establishing additional standards for the accreditation of hospitals and hospital services and further defining hospital groupings and the special standards they must meet.

Merger

A hospital merger involves the merging of two or more previously separately accredited hospitals situated no more than 35 kilometres apart under a single administrative entity with a single recognition. The regulations ensure a balanced distribution of services and functions amongst the various locations of the merged hospitals.

Over time, various waves of hospital mergers have taken place in Belgium. These were spurred on in part by amendments to legislation. In 1998, hospitals were encouraged to enter into a voluntary merger as a result of:

• The abolition of the mandatory surrender of 5% of the overall bed count;
• An increase of the permissible distance between the hospitals entering into the merger from 10 km to 35 km.

In 2014, a number of hospitals merged following the sixth state reform.

Other motivations for mergers include simplifying collaborations, cost savings, increasing efficiency, and improving the quality of care.

Evolution of mergers of general hospitals in Belgium

Learn more?
Royal Decree further defining the merger between hospitals and the particular standards it must meet

Hospital networks

The creation of locoregional hospital networks aims to encourage hospitals to use resources more efficiently, share investments and promote a division of labour based on expertise.

What are locoregional networks?

Since 1 January 2020, every general hospital has been obliged to form part of one, and only one, locoregional hospital network[5]. A maximum of 13 networks may be formed in Flanders, 8 in Wallonia and 4 in Brussels. The locoregional hospital network is tasked with organizing the locoregional healthcare services within their network.

In 2025, there are 23 locoregional hospital networks in Belgium.

The goal underlying working with locoregional hospital networks is to create an appropriate framework that encourages collaboration within the sector. The aim is for hospitals to continue to offer care that is needed for their care area and to do so in collaboration with hospitals within their network. Hospitals within a network may choose to bring together various services and care packages in the form of shared services, thereby ensuring that resources can be used more efficiently by, for example, making group purchases or operating heavy equipment or infrastructure together.

The aim of the measures is to enable locoregional hospital networks to become more attractive to professionals and patients by improving quality and specialisation. Cooperation with reference centres offering supra-regional care will allow patients who have undergone complex forms of treatment to continue receiving additional follow-up in a locoregional hospital near their place of residence. The chart below illustrates the size of each network based on the number of accredited beds. On 1 January 2025, the Chorus and Elipse networks had the highest number of accredited beds, with 4,462 and 3,915 beds, respectively.[6]

Number of accredited beds per locoregional hospital network (01/01/2025)

Learn more?
The coordinated Act of 10 July 2008 on hospitals and other care facilities, regarding clinical networking between hospitals

Working together to perform care assignments

“Care should be provided in the vicinity where possible and specialised care where needed”

The basis of the reform introducing locoregional hospital networks is twofold: “Care should be provided in the vicinity where possible and specialised care where needed”. In other words, the government wants to ensure that, whenever possible, care is provided as close to home as possible, but also that, from a quality perspective, highly specialised care is more likely to be concentrated in certain locations. A subdivision of care was drawn up that divides healthcare into locoregional care assignments and supra-regional care assignments.

1. Locoregional care assignments
These are the care assignments that should be offered in each locoregional hospital network. On the one
hand, this is understood to refer to general care assignments in the case of conventional operations and
conditions, such as an emergency department, a geriatric or paediatrics service, etc., which may be offered
in any hospital. On the other hand, locoregional care includes care assignments that require patients to
come to the hospital regularly for a certain period of time. These include kidney dialysis, the oncology care
programme and the stroke care programme. These types of care must be offered in every hospital network,
but not in every hospital.                                                                            
2. Supra-regional care assignments
These involve care assignments for a small group of people that require considerable expertise and/or
investment. These types of care should not be offered in all hospital networks but must be concentrated in
supra-regional reference centres. These include specialised stroke care, burn centres, paediatric oncology
centres, and so on.

In 2022, the Royal Decree was published that lists the locoregional and supra-regional care missions for hospital networks. That Royal Decree regarding the qualification of healthcare missions additionally establishes an organic, federal accreditation standard. This standard states that it must be possible for locoregional care missions to be offered within a 30-minute drive of 90% of inhabitants, within the operating area of the hospital network.

The two maps below illustrate the accessibility of locoregional care missions involving maternity and emergency care. One can observe that especially in the border areas as well as in some areas in the south of the country, it is not possible to guarantee that these services can be accessed within a 30-minute drive.

Accessibility of an emergency department within 30 minutes (12/02/2025)

Accessibility of a maternity unit within 30 minutes (12/02/2025)

Learn more?
Royal Decree qualifying the supra-regional care assignments and the locoregional care assignments of the locoregional clinical hospital networks and determining the geographical range of locoregional care assignments of the locoregional clinical hospital networks

^{[1] This report will focus on the general hospitals under federal jurisdiction and will leave out psychiatric hospitals (which provide care exclusively to people with mental disorders) and exclusively specialized hospitals (with the exception of Foyer Horizon).}

^{[2] An exception is made in the case of those hospitals that consist exclusively of specialised services for treatment and rehabilitation whether or not in conjunction with ordinary hospitalisation or neuropsychiatry departments for the treatment of adult patients.}

^{[3] Source: FPS Public Health (1 January 2025). Hospital Infrastructure Repository (HIR). [Dataset]; psychiatric beds decommissioned under the so-called 107 article were included in these figures.}

^{[4] For more information on this, please consult the publication ‘Key Data in Healthcare – Mental Healthcare’.}

^{[5] An exception applies in the case of psychiatric hospitals and general hospitals that only have psychiatric hospital services (identification letter A, T or K) together with specialised treatment and rehabilitation services (identification letter SP) or a geriatric service (identification letter G). The last of those exceptions applies to two hospitals under federal jurisdiction, that do not form part of a locoregional hospital network. These are Silva Médical and Valisana.}

^{[6] The number shown in the graph represents the number of accredited beds in the hospital network in relation to the total number of accredited beds in all Belgian general hospitals under federal jurisdiction that are part of a locoregional hospital network. Ziekenhuisnetwerk KOM and Ziekenhuisnetwerk Noord-Oost Limburg actually have more beds, as specialized hospitals (which do not fall under federal jurisdiction) are also part of the hospital network.}