The majority of hospitals in Belgium are in a "precarious financial situation", according to a new report, which highlights an overall financial loss for the first time in 2022.
The 29th MAHA (Model for Automatic Hospital Analyses) report, published by Belfius, outlines that the Belgian healthcare sector reported a deficit of €181 million in 2022, mainly due to rising costs of staff wages (+14.5%), energy (+62%) and food products (+17%). The sector's annual budget was also impacted by an 8% rise in salaries due to automatic indexation.
Out of 86 general hospitals (excluding university hospitals and psychiatric clinics), 49 reported a loss in their operating results in 2022. 24 hospitals achieved an ordinary operating result of less than 1% of turnover.
“84% of hospitals are in a precarious situation,” the report’s authors note. The trend can be seen in all regions. The report did qualify that when considering exceptional items, such as adjustments from previous years, the 2022 fiscal year ended with a positive result of €37 million.
2022 saw a 2% increase in the total workforce in Belgium's hospitals (an additional 2,134 full time equivalents), with staff numbers increasing the most in Wallonia (+2.6%).
However, the report notes that only 402 of these additional roles were nursing positions, and there were still 2,800 nursing roles vacant in 2022 (+20%).
'Alarm signal' for hospitals
The report highlights the deteriorating solvency and liquidity of Belgium's hospitals. It warned that hospital debt continues to rise and now accounts for 32% of the balance sheet. This increase is particularly notable in Wallonia (38.3% of the total balance sheet) and Brussels (41.1%).
"Flanders is currently experiencing a slowdown in the investment wave for hospital renovations. Debt there has slightly decreased to 26.1% of the total balance sheet," the report specifies.
This financial strain affects hospitals’ ability to invest and maintain their facilities. It also hampers efforts to promote day hospitalisation, according to Dr. Philippe Devos, president of Unessa, the multi-sector federation of care and support structures.
"Hospitals struggle to finance equipment that supports day hospitalisation. In more advanced countries, some equipment is moved to the patient’s home. Our system does not yet support this."
A 'chronic lack of interest'
The outlook for 2023 also indicates "chronic difficulties" for the sector, with another negative operating result anticipated and continued rising costs, especially related to staff and energy.
"This lack of interest and awareness of the hospitals’ situation cannot continue. Without significant refinancing measures, we will inevitably see a decline in care quality, innovation, and investment, putting more pressure on staff and leading to further staff shortages and rising costs for patients," warns Santhea, the federation of healthcare institutions in Wallonia and Brussels, in a statement.
Health Minister Frank Vandenbroucke has called for a reform of the hospital financing system to "ensure more stability and transparency. The new financing method should also promote collaboration within and between hospitals, and create a new model of cooperation between doctors and hospital administrators."
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Vandenbroucke also stressed the need to reform the nursing profession: "Such a comprehensive reform is essential to prepare our nursing care for the future and make the profession more attractive." He added that nursing staff are often assigned tasks "that could be done as well or better by others", such as administrative chores, housekeeping, or basic hygiene care.
"Moreover, the autonomy of nurses remains too limited for them to fully utilise their skills. For example, a nurse still needs a medical prescription to administer a painkiller to a patient."
