14 Flemish Hospitals Face Restructuring as Belgium Overhauls Fragmented Care
Belgian health ministers have reached a landmark principled agreement to restructure the country’s hospital landscape, identifying 14 Flemish general hospitals that risk having to scale down operations or close certain departments. The reform, announced on June 24, 2026, by the Interministerial Conference on Public Health, aims to address what officials describe as an unsustainable level of fragmentation in the healthcare system, according to Het Laatste Nieuws.
The Fragmentation Problem
Belgium currently operates 132 acute care sites across the country, a density that experts and ministers agree is no longer viable. With an aging population, chronic staff shortages, and rising costs, the system faces mounting pressure. The FOD Volksgezondheid confirmed that both experts and ministers emphasize the urgency of adapting the system, noting that care is becoming increasingly complex and healthcare personnel are too thinly spread to respond efficiently.
Federal Health Minister Frank Vandenbroucke (Vooruit) commissioned an expert report in 2025, delivered in December of that year, which formed the basis of the reform. The report recommended establishing four types of healthcare facilities: University Hospitals, Regional General Hospitals (RAZ), Local Medical Centers for Day Care (LMC/ZDZ), and Intermediate Care Hospitals (ZIZ).
The 14 Hospitals at Risk
To qualify as a Regional General Hospital (RAZ), a facility must have at least 200 beds, of which 150 must be acute beds with sufficient occupancy. The original expert recommendations were stricter, but ministers slightly relaxed the criteria. Hospitals in remote areas may receive more lenient treatment.
Across Flanders, the affected hospitals are distributed by province: three in West-Vlaanderen, five in Oost-Vlaanderen, three in Antwerpen, two in Vlaams-Brabant, and one in Limburg. Among the identified facilities are AZ West in Veurne, which has 236 beds but only 146 acute beds, and AZ Delta campuses in Menen and Torhout, which fall below the acute bed threshold. In Oost-Vlaanderen, AZ Oudenaarde — with 179 beds — has already initiated merger talks with AZ Glorieux in Ronse, with the merger expected in 2027. In Limburg, ZOL campus Sint-Barbara in Lanaken will be converted into a specialized day center, with acute beds and operating theaters moving to the main site in Genk.
No Forced Closures
Minister Vandenbroucke has stressed that no hospital will be forced to close. “It is absolutely not the intention that hospitals will close,” he stated. Affected hospitals have several options: merging with another institution, converting to a day clinic (LMC), or becoming an intermediate care hospital (ZIZ). The VRT NWS reported that for Limburg, hospitals in Maaseik and Tongeren are guaranteed to remain open until at least 2032.
Jürgen Ritzen, spokesperson for ZOL, confirmed the approach: “The campus is not closing, but it is being transformed.” The Sint-Barbara site will retain its multidisciplinary pain center and potentially its rehabilitation center.
Industry and Expert Reactions
Healthcare sector leaders broadly support the reform’s direction while raising concerns about implementation. Margot Cloet, CEO of Zorgnet-Icuro, warned: “If we do nothing, the sector will collapse.” Joost Baert, CEO of AZ Delta, expressed support for greater efficiency but noted the need for financial backing: “I am a big believer in more efficient healthcare… Only there will also need to be financial support for all infrastructure adjustments, but I haven’t heard anyone talk about that yet.”
Bert Cleuren, General Director of AZ West, emphasized that restructuring must be done thoughtfully, particularly given the geographic isolation of certain hospitals serving aging populations and tourist areas.
The Vlaamse Raad WVG issued an advisory opinion supporting the reform but calling for a broader shift toward integrated care, warning that the hospital reform cannot stand alone.
Implementation Timeline
The reform will be implemented in two phases over ten years (2026–2036). The first phase must be completed by 2031, with hospitals that do not meet the 150 acute bed threshold required to transform by 2029. Final approval of the reform is expected in September 2026, after which the detailed modalities will be further developed. A transitional period with subsequent evaluation is built into the plan.
Broader Implications
The reform is linked to broader changes in hospital financing, nomenclature reform, and the evolution toward more integrated care. According to the KCE, an online simulation tool has been developed to model the reform’s impact, allowing policymakers to test scenarios such as mergers, site repurposing, and the relocation of emergency and maternity services.
While the consolidation of specialized expertise in larger hospitals promises improved quality and financial sustainability, it also raises concerns about accessibility. Some patients will face longer travel times for emergency care, particularly in rural areas. The reform’s success will depend on whether the government provides adequate transition funding and coordinates the hospital changes with primary care and financing reforms.
What to Watch For
With final approval expected in September 2026, the coming months will be critical for determining the reform’s final shape. Key questions include whether a transition fund will be established for infrastructure changes, how criteria will be applied to geographically isolated hospitals, and whether the 2031 deadline is achievable. The reform’s impact on hospitals in Wallonia and Brussels also remains to be fully detailed.