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This paper opens with the statement that the Belgian health care system finds itself nowadays in a paradoxical position as the favourable appreciation of its performance and high quality level resulting from both international comparisons and recent national enquiries among the Belgian population on the one hand, and the significant growth of the compulsory health assurance budgets over the past few years on the other hand, strikingly contrast with far less positive aspects of the actual situa- tion mainly reflected by the ever increasing burden of health care costs to be supported by patients, by serious accessibility problems for some categories of the population and by an overall feeling of dissatisfaction among health care providers. Pointing out the main issues the system has to cope with in four different key areas (financing, health care structures, administrative structures, institutional structures), the paper formulates a series of reflections and proposals in order to stimulate the debate.