• The international economic crisis began in Belgium in 2008, as it did for other European

countries, but its effects on public sector spending were not immediately or deeply felt
for several reasons, including having a caretaker government in place between June
2010 and December 2011, a period in which major policy decisions could not be taken.
However, in 2012, the new government had to implement a package of austerity
measures to make €11.3 billion worth of public sector savings, of which €2.3 billion
were in the health sector. Prior to 2012, the health budget had been cushioned from
any cuts by two factors: the existence of a long-standing and generous growth cap,
which effectively guaranteed a 4.5% annual increase in the health budget every year;
and the existence until 2012 of health budget surpluses that could be drawn from. In
2012, no growth cap was applied, and given the new economic climate, much smaller
ones were applied in 2013 and 2014. Despite these favourable circumstances, the
impact of the crisis from 2012 galvanized policy-makers into realizing that the status
quo was no longer an option and that efficiency measures were needed in the health
care sector. At the same time, attention was paid to maintaining and enhancing financial
protection mechanisms for economically vulnerable groups.
• Developing countries were hit hard by the financial and economic crisis, although the
impact was somewhat delayed. Every country had different challenges to master. The closer
the developing countries are interconnected with the world economy, the crasser the
effects. And the incipient recovery that is becoming noticeable is, for the time being,
restricted to only a few countries and regions.
The crisis was transmitted primarily by trade and financial flows forcing millions back into
poverty. Attainment of the Millennium Development Goals is seriously jeopardised in many
countries. Many developing countries did not and do not have the resources to stimulate
the economy and protect their socially disadvantaged populations to the same extent as
the industrialised countries. However, many countries have made considerable efforts to
mitigate the effects. Developing countries have also increased their cooperation with one
another and are urgently demanding a greater voice in global economic affairs.
The industrialised countries are for the most part more concerned with their own
problems. Their readiness to provide more extensive aid is limited. They are under pressure
from the international institutions to relax their previous dominance in favour of the
increasingly strong emerging countries. A shift in power and influence that was already
noticeable before the financial crisis is deepening.