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This paper opens with the statement that the Belgian healthcare system finds itself in a paradoxical position as the favorable perception of its performance and high level of quality shown in international comparisons and recent national surveys among the Belgian population as well as significant growth in compulsory health assurance budgets over the past few years strikingly contrast with far less positive aspects of the actual situation, which is reflected mainly in the ever-increasing burden of healthcare costs having to be supported by patients, serious accessibility problems for some categories of the population, and an overall sense of dissatisfaction among healthcare providers. Pointing out the main issues the system must cope with in four key areas (financing, healthcare structures, administrative structures, and institutional structures), the paper formulates a series of reflections and proposals in order to stimulate the debate.