The Belgian healthcare system has a system of compulsory insurance with almost universal coverage of the population (99 per cent), administered by healthcare sickness funds (mutualité’s). Citizens can choose a mutualité freely, and can switch between mutualités at any time. Mutualités do not negotiate directly with individual hospitals, negotiations take place at the national level. Hospitals need to meet a limited set of national criteria in order to obtain recognition and must fit within standards for national programming. Most physicians in Belgium work within the Belgian state health insurance scheme, while some combine this with private work or work entirely in the private sector. Future developments involve proposals for strengthening value based financing of healthcare and clustering of hospitals, the latter creating a network of neighbouring hospitals, a development aimed at sharing of the financial risks between hospital and insurance.