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Other official information and services:  belgium

The Pay for Performance programme (P4P) was launched in 2018 for general hospitals as part of the hospital financing reform. The goal of this programme is to financially reward hospitals that achieve good results on a set of hospital-wide and pathology-related structure, process and outcome indicators. These indicators include obtaining ISQua accreditation certification and implementing a patient safety management system. It also focused on oncology indicators, such as the correct and complete transmission of data regarding the clinical and pathological stage of tumours, and mortality indicators. In recent years, there has been more of a focus on patient experiences. Hospitals receive a financial incentive based on the scores they achieve for the indicators and for the justified activity (the number of accredited beds).

The ISQua (International Society for Quality in Healthcare) accreditation quality indicator has been part of the P4P programme since its inception in 2018. To achieve ISQua accreditation, the hospital is assessed by an external, independent organisation to determine whether it is providing quality and safe care to patients. Obtaining accreditation certification requires a great deal of effort from the hospital.

Hospitals are financially rewarded in P4P, both for achieving ISQua accreditation certification and for the preparation process for hospital-wide accreditation.


Evolution percentage of hospitals by stage of accreditation


‘Increase from 17 to 39 hospitals without an ISQua accreditation in the period from 2018 to 2022.’

In the P4P programme in 2018, 46 hospitals were ISQua accredited. By 2020, there were 65. Starting in 2021, however, there was a noticeable decline. More and more (Flemish) hospitals are choosing not to reaccredit. Between 2020 and 2021, 4 Flemish hospitals decided to stop their ISQua accreditation process. Between 2021 and 2022, that number rose to 15 hospitals, almost a fourfold increase. In Brussels, between 2020 and 2021, only 1 hospital decided to no longer participate in ISQua accreditation. In Wallonia no hospital has discontinued ISQua accreditation. On the contrary, the number of Walloon hospitals with ISQua accreditation increased from 4 hospitals in 2018 to 13 hospitals in 2022.