xiv, 94 p. ; This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance. The incidence of catastrophic health spending is higher in Belgium than in most other countries in western Europe. It is heavily concentrated in the poorest fifth of the population and among households headed by unemployed or inactive people. Rates of unmet need for health care and dental care in Belgium are similar to the European Union average, but there is a significant gap in unmet need between the richest and poorest people. The factors that undermine financial protection in Belgium include gaps in all three dimensions of health coverage (population coverage, service coverage and user charges) and administrative barriers. At least 1% of the population is uninsured, rising to at least 2% in the Brussels region and among younger adults and self-employed people. On average, catastrophic spending is driven by out-of-pocket payments for medical products (owing to gaps in the benefits package) and inpatient care (reflecting widespread balance billing). In the poorest consumption quintile, however, it is mainly driven by outpatient medicines, diagnostic tests and outpatient care. The Government has recently taken steps to strengthen financial protection, but more can be done to simplify Belgium’s unusually complex coverage policy and reduce co-payments and other out-of-pocket payments, particularly for low-income households – for example, abolishing retrospective reimbursement for all health services; extending the annual cap on co-payments to all health services and lowering it for people with very low incomes; granting automatic entitlement to everyone eligible for increased reimbursement (reduced co-payments); limiting balance billing in outpatient and inpatient care; and strengthening regulation of the price of non-covered medical products.