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KCE Reports 133 Special Solidarity Fund 151
9.10 RESULTS OF THE INTERVIEWS WITH THE
REPRESENTATIVES OF THE SOCIAL SERVICES
9.10.1 Knowledge on the existence of the SSF
The interviewed social workers have gained knowledge on the existence of the SSF
trough the following channels: colleagues from the hospital’s social service , the sickness
funds, during their bachelor degree “social work”, via the medical doctors of the
hospital, via the cancer league, via a previous work experience in a sickness fund and
finally via the SSF brochure. One notices the majority of social workers got this
information from inside the hospital.
9.10.2 General information on SSF cases
The number of cases yearly submitted to the SSF by the social workers interviewed
ranges between 40 (university hospital – big applicant) and 1 or 2 cases. This number
can vary substantially over the years, depending on the patient’s profiles, the evolution
of the regulatory health insurance coverage and the criteria set by the SSF.
Respondents indicated that the number of cases has decreased substantially over the
years due to inclusion (and reimbursement) of previous SSF cases into the regular
health insurance system.
The social services stipulated they don’t have the requisite medical knowledge to assess
the SSF files on content. Only when they know that one or more SSF criteria aren’t
met, they inform the medical doctor of the possible non eligibility for reimbursement of
the case by the SSF. This action can lead to the decision to stop the procedure on
preparing or entering a SFF file.
None of the respondents could inform us on the exact number of applying medical
doctors within their hospital (at hospital level) as the social services are not necessarily
involved in the submission of all the SSF files (medical doctors can submit a SSF file on
their own or patients can go directly to their local sickness fund to apply for SSF
intervention). All respondents reported they have contact with a limited number of
applying medical doctors, some respondents reported an exact number, ranging
between 1 and 5. Since social workers are linked to medical services or hospital wards,
this number does not represent the total number of medical doctors concerned. The
data on SSF applications are not consolidated at hospital level. The global number of
medical doctors involved in SSF cases clearly depends of the size of the hospital and the
grade of specialization within the medical services and disciplines, but even in big
university hospitals the global number of staff members implicated in SSF applications is
limited. The following medical disciplines were linked to SSF cases: (pediatric) oncology,
cardiology, (pediatric) neurology, metabolic diseases, nephrology, urology, hematology,
gastroenterology and digestive surgery, radiotherapy and pulmonary diseases.
9.10.3 Need for a safety net/relevance of the SSF/effectiveness of the SSF
On the question “Why has a safety net as the SSF been established next to the regular
health insurance system?” the respondents gave two major reasons which they see as
major objectives for the SSF:
• To cover the costs of necessary and expensive medical treatments which
are not (yet) included and reimbursed in the regular health insurance
system. As such the SSF should be a real safety net and provide financial
support to patients facing such situations. The objective mentioned is
clearly based on the solidarity principle.
• To identify expensive medical treatments, drugs or medical devices which
are not included in the regular health insurance system in order to gain
knowledge on the use and the effectiveness of them and to document a
later decision on eventual transfer to reimbursement by the regular health
insurance system.
As a consequence, the SSF assures access to medical care through financial support
(solidarity principle) in a kind of “waiting room” modus.