Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

88 Special Solidarity Fund KCE Reports 133
Although there is no strict criterion for the delegation to one member of the SSF, the
data analysis on the SSF sample reveals that decisions on renewals are to an increasing
extent delegated to the leading medical officer of the SSF.
8.3.3 Administrative burden
The administrative burden is reported to be primarily situated at the level of the social
service of the hospital. There is consensus between the interviewees that the
administrative burden is heavy. The following examples illustrate this statement:
• Administrative formalities for renewals although it is clear the patient will
need the treatment for a long period;
• Providing the same information for comparable cases the SSF already
possesses resulting in duplication of information (and workload);
• Provision of information which is already at the disposal of the SSF as part
of the NIHDI (financial costs of material, drugs, …);
• Obligation to provide the hospital’s invoice for the material or the drug
when entering a SSF file. This is a heavy administrative workload and can
easily be postponed till after a positive decision on the application. For the
financial department the search of invoices (invoice to the hospital) is
rather complicated since drugs and medical devices are not bought piece
by piece and invoices contain various products;
• Non acceptance of an electronic signature on the medical file entered by
the prescribing medical doctor.
At patient level the provision of the declaration on honor that all other legal
reimbursement sources in Belgium as well as abroad, or reimbursement by private
insurance have been exhausted can cause problems. Our research showed that this is a
purely administrative item and that the SSF is not able to check the existence of possible
individual rights to reimbursement or if a patient has already (eventually partially) been
compensated through other channels. However it can cause a delay on the decision if it
is missing. It might result in a non reimbursement if the patient died in the meantime.
8.3.4 Reporting and transparency
For decisions taken by ‘one member of the College’ only negative decisions are also
signed by a second member of the college (medical director of the sickness fund of the
patient). No further reporting is being organized. For delegated decisions to the local
sickness funds, the only reporting is financial via the NIHDI.
All stakeholders clearly stress the unclearness of (the interpretation of) several criteria.
The motivation of the decisions is perceived as administrative since the legal criteria on
which the decision was based are mentioned.
Currently legislation provides that an annual report has to be presented to the
Verzekeringscomité/Comité de l'assurance and the Algemene Raad/Conseil Général.
There is no legal obligation to make these annual reports publicly available.
8.3.5 Stakeholder involvement
The SSF is perceived as very distant and totally absent from the healthcare scene. No
contacts exist with patient groups, the medical profession or the hospital services. Such
contacts are reported to be avoided and even refused. Dissemination of the decision to
the respective social service the patient contacted or the treating physicians is absent.
Yet, this information is conceived as necessary by these stakeholders. Individual
decisions on applications are not transferred to the providers of drugs or devices
subject to the SSF application (delivering medical companies). As such this is acceptable
and obvious because of privacy issues.
In principle it is possible to contact the SSF; the phone number and the email address
are mentioned at the NIHDI website.