The National Institute for Health and Disability Insurance (Institut national d'assurance maladie-invalidité, INAMI) reported on 13 April 2026 that aggregate healthcare expenditure finished 201.2 million Euros below the approved budget of 39.7 billion Euros. This global underspend masks a recurrent deficit in pharmaceutical specialties, which exceeded its allocated envelope by 104 million Euros. Offsets from care segments such as home nursing and medical fees preserved the national fiscal balance but highlight a growing strain in drug funding.
INAMI attributed the pharmaceutical deficit primarily to a shortfall in receipts from Article 81/111 managed entry agreement company reimbursements (Conventions de remboursement, CR). In 2025, these receipts were 145.7 million Euros lower than predicted.
The system triggered an additional recovery from manufacturers worth 85.4 million Euros following a projected overspend in November 2025. This clawback failed to fully neutralise the growth of the sector, suggesting that existing payback mechanisms are struggling to keep pace with the entry of high-cost therapies. Institutional power in Belgium remains focused on refining these financial levers as the General Council (Conseil général, CG) prepares the 2027 technical estimates for May 2026.
Further pressure was visible in hospital day-price expenditure, which surpassed the budget by 121 million Euros due to catch-up payments. INAMI intends to publish detailed sector audit reports by July 2026. However, these figures demonstrate that while Belgium maintains macro-budgetary discipline, pharmaceutical spending remains the primary point of technical and fiscal tension.
Source: Institut national d'assurance maladie-invalidité (INAMI)
Link: L’INAMI : les dépenses pour les prestations de santé restent dans le cadre budgétaire en 2025 (NIHDI: health care expenditure remains within the budget framework in 2025)
Date: 13 April 2026
