Belgium’s Health Gap Widens: Poorer Pay More, Get Sicker

A major new study from CM Gezondheidsfonds (Christian Mutual Health Insurance Fund) reveals that health inequality in Belgium is deepening, with lower-income citizens experiencing significantly worse health outcomes while spending a far larger share of their income on medical care. Based on data from 4 million members extrapolated to the national population, the findings paint a stark picture of a system where those who need care most have the least access to it.

The Scale of the Divide

The study, which analyzed 20,000 neighborhoods by median fiscal income, found that in 2023 the mortality rate was 51% higher in poor neighborhoods (1.13%) compared to wealthy ones (0.75%). Chronic diseases follow the same pattern: diabetes is twice as common in the poorest areas (10.8%) compared to the richest (5.4%), according to VRT NWS.

Residents of the poorest neighborhoods face up to a 23% higher risk of hospitalization and a 39% higher risk of emergency department visits. The disparities extend to mental health as well, where the risk of psychiatric hospitalization is up to 2.8 times higher for those in low-income areas compared to wealthy ones.

A Paradox of Access

Perhaps the most troubling finding is what CM calls the “care access paradox”: those with the greatest health needs use healthcare the least. People in vulnerable neighborhoods more often postpone non-urgent care — usually for financial reasons — and end up in emergency departments when conditions worsen.

“The inequality is the result of an accumulation of barriers that hinder access to care,” said Luc Van Gorp, Chairman of CM Gezondheidsfonds, as reported by CM’s press release. “In 2026, this inequality should no longer exist.”

The preventive care gap is equally stark: in the wealthiest neighborhoods, 71% of women participate in breast cancer screening, compared to only 45% in the poorest.

Financial Burden on the Poor

The financial dimension of health inequality compounds the problem. Low-income households spend an average of 8% of their budget on healthcare — nearly six times more than the 1.4% spent by the highest-income group.

Belgium’s protective mechanisms, such as the “maximumfactuur” (maximum bill) that caps annual out-of-pocket payments, are falling short. According to CM, patients must first pay upfront before the cap kicks in, and the system does not cover fee supplements or extra costs. Additionally, approximately 30% of people with very low incomes do not have the “verhoogde tegemoetkoming” (increased reimbursement status) despite likely being eligible.

A Growing Trend

Health inequalities in Belgium increased between 2011 and 2023, and the gap is growing faster than in other European countries. A 2020 report by the European Social Observatory, commissioned by RIZIV/INAMI, had already warned that “disparities between socio-economic groups remain significant and have even increased over the last decade.” The new CM data suggests this trend has accelerated.

Political Implications

The findings carry significant political weight. Health Minister Frank Vandenbroucke (Vooruit), who has positioned himself as an architect of accessible, social healthcare, now faces uncomfortable questions. As P-Magazine noted in its analysis, despite years of reforms and increased spending, the health gap continues to widen.

CM’s Proposed Solutions

CM has put forward several concrete recommendations to address the crisis:

• Expand the third-party payer system so low-income patients don’t need to pay upfront
• Further develop neighborhood health centers (wijkgezondheidscentra), which have proven effective at nearly eliminating the primary care access gap
• Reorganize the maximum bill so that once the threshold is reached, patients don’t need to advance payments
• Strengthen the maximum bill to better align with households’ actual financial capacity

“Those who need care the most are also those who have the least access to it and pay the highest price,” Van Gorp said. “Protection mechanisms are too limited and kick in too late.”

A Bright Spot

There is one notable exception to the troubling trend: neighborhood health centers succeed in nearly eliminating the gap in primary care access. By allowing patients to receive care without upfront payments and through multidisciplinary collaboration, these centers reach vulnerable groups more effectively than traditional GP practices.

What to Watch For

As Belgium’s political landscape evolves, the question of how the government will respond to these findings remains open. The study adds urgency to calls for systemic reform of the country’s healthcare financing model, particularly the mechanisms meant to protect the most vulnerable. With health inequality growing faster in Belgium than in peer European nations, the pressure for meaningful policy change is mounting.