Before the so-called 'bill Moureaux ', the health insurance policy in Belgium was contracted out by the government to the health workers and the health funds. Also in other sectors (hospitals), government contracted out. This subsidiarity has advantages and disadvantages. Especially because of the unbearable budgetary excesses, this situation started to change since the beginning of the eighties, starting with the hospital sector. In the early nineties, the management of the sickness insurance also went through some radical changes. The budgetary envelope (budget objective) is now mainly established by those who finance the system, e.g. the government and the social partners (employers and workers), who must take their responsibilities. In this new perception, all partners must be made truly accountable. Government must pass on statistic material in order to be able to pursue a well-informed policy. It must also crank up some social debates, namely about the demographic ageing. Health funds and organisations of physicians need a further democratization. The health funds must accomplish at the same time several functions: pressure group, service and consumer defence.