Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
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<strong>KCE</strong> Reports 133 Special Solidarity Fund 159<br />
9.10.10 The internal SSF procedure within the hospital<br />
9.10.10.1 The initiator and final responsible for SSF applications<br />
• The medical doctor was indicated in all interviews as the initiator of SSF<br />
files submission. The social service was sometimes mentioned as<br />
additional/complementary initiator. They intervene as an initiator when<br />
contacted by a patient on financial problems but also anticipate when they<br />
are aware of a situation (medical treatment) where an application for<br />
reimbursement by the SSF could be envisaged. The fact the social workers<br />
are operationally linked to the medical service of the hospital enhances<br />
the possibility for <strong>de</strong>tection of such cases. Patients can play an active role<br />
in the initiation when they know the SSF or when communicating their<br />
financial problems with the hospital staff (nurses, medical doctors). The<br />
pharmacy <strong>de</strong>partment and invoice <strong>de</strong>partment were both mentioned<br />
twice as an initiator. They have a signal function when they <strong>de</strong>tect the<br />
or<strong>de</strong>ring of very expensive drugs or i<strong>de</strong>ntify invoices for very expensive<br />
materials.<br />
• The final <strong>de</strong>cision to submit a file to the SSF is clearly a medical <strong>de</strong>cision.<br />
In all interviews the treating medical doctor is indicated as the ultimate<br />
responsible and <strong>de</strong>ci<strong>de</strong>r. Structural involvement of the social service has<br />
been mentioned; as well as the invoice <strong>de</strong>partment and the pharmacy<br />
<strong>de</strong>partment.<br />
• In the hospitals where there is structural involvement of the social<br />
/financial or pharmacy <strong>de</strong>partment in the final <strong>de</strong>cision, these <strong>de</strong>partments<br />
advice the treating medical doctor on the SSF procedure. If they are<br />
convinced SSF criteria aren’t met, the social services stop the procedure<br />
of submission to the SSF. In the other hospitals, the social services don’t<br />
take up such a role since it’s not their competency and responsibility or<br />
because the situation has not yet occurred.<br />
• None of the social workers gives a specific prognosis on the changes of<br />
success for SSF files to patients in or<strong>de</strong>r not to create false expectations.<br />
This is a generalized hospital policy that counts for every intervention of<br />
the social services.<br />
9.10.10.2 More or less involvement of the social services in the internal procedure<br />
Many respon<strong>de</strong>nts ask for more involvement in SSF files. The request for more<br />
involvement is situated at two levels: the SSF and the hospital<br />
• Towards the SSF, the main requests are related to having information<br />
regarding the final <strong>de</strong>cision and more specifically the reasons/motivation<br />
why a file is approved/<strong>de</strong>nied. Some interviewees would also appreciate<br />
more information on the status of a file (which step in the procedure?<br />
practical planning) and more transparency on SSF criteria and global<br />
<strong>de</strong>cisions.<br />
• Internally, at hospital level there is the aim to be more involved in the<br />
initiation of SSF files to avoid potential SSF applications not being <strong>de</strong>tected<br />
and as a consequence prevent situations where patients don’t get<br />
reimbursement, provi<strong>de</strong> more support on content and finally more<br />
internal administrative coordination of SSF files.