Hospital networks, as defined by the law of 28 February 2019, remain challenging even after some time has passed since their creation. These networks aim to improve healthcare in terms of quality, accessibility and affordability by promoting cooperation between hospitals within a region. Although the law provides guidelines for the establishment and operation of these networks, there are still several obstacles that frustrate hospital cooperation and the objectives intended by hospital networks.
One of the main obstacles is the delay in adopting essential Royal Decrees needed to make hospital networks operational. Without clear guidelines and regulations, it can be difficult for hospitals to know how to cooperate and what role they should play within the network.
In addition, Article 96/1 of the Zieknhuis Act under which the minister can allocate a separate budget of financial resources to a hospital network has not yet been used. There is thus a lack of clarity on the rules regarding the allocation of budgets to the various hospitals within the network. This can lead to tensions and disagreements among the participating institutions, which can jeopardise cooperation and the ultimate goal of improving healthcare.
Another major bottleneck in the hospital networks was determining the locoregional and supra-regional care assignments. This was resolved by a royal decree of 23 November 2022, which determined the geographical range of these assignments. Although the law allowed to distinguish between general and specialised care assignments, the current health minister decided not to use this distinction due to the diversity of networks. However, this decision resulted in a lack of clarity and may be confusing for hospital networks, especially as the law still requires that the offer of general and specialised care assignments be coordinated within the network.
The law of 29 March 2021 also added confusion by exempting the creation and subsequent changes of locoregional clinical hospital networks from merger control by the Belgian Competition Authority (BMA). The minister interpreted this as exempting internal regroupings within the network, but the BMA argues that mergers and acquisitions still fall under its supervision because of their structural impact. This difference in interpretation leads to confusion and additional administrative burden for hospitals pursuing collaborative projects within the same network. The government is considering a preliminary draft law to exclude the hospital sector from merger supervision by the BMA to promote administrative simplification.
In short, although hospital networks have great potential to improve healthcare, there remain obstacles to overcome. It is essential that policymakers and stakeholders work together to address these challenges and ensure that hospital networks can function effectively for the benefit of patients and healthcare providers.