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

172 Special Solidarity Fund KCE Reports 133
• The patient organisations don’t systematically provide information
towards the sickness funds. Ad hoc contacts are always linked to specific
SSF cases where further clarification is needed. Patient organisations only
intervene when they receive a specific request from a member.
• Some organisations indicate that they maintain(ed) extensive contacts
with politicians to get attention for the specific situation of the members
they represent. These actions resulted in numerous parliamentary
questions. They also gave the opportunity to have some specific individual
patient situations put in the spotlight. These also raised media attention
and created and more public awareness for rare diseases. Structural
contacts directly related to the SSF with the ministry of health are
seldom.
9.12 RESULTS FROM THE INTERVIEWS WITH THE
PRESCRIBING PHYSICIANS
9.12.1 Knowledge on the existence of the SSF
Most doctors learned of the existence of the SSF from their practice. None of the
interviewees got preliminary information directly from the SSF itself. The following
channels were mentioned: from the hospital’s social service, the sickness funds or its
medical advisor, from colleagues, via a pharmaceutical company. Finally one interviewee
could not recall how he first heard about the existence of the SSF.
9.12.2 General information on SSF cases
The number of cases submitted to the SSF is variable. Five of the respondents have a
very limited number of SSF cases (1 to 2 on an annual basis) at the moment. Most of
them had more cases in the past. The diminishment of the number of cases originates
from drugs or medical devices that were transferred to the regular health insurance
system or drugs that have been accepted as orphan drugs. Five other respondents have
between 5 and 10 SSF files a year, 2 have between 10 and 15 cases and one has about
20 SSF files a year.
Most of the medical doctors keep no separate track of SSF files and have no
consolidated data on SSF applications. For some medical doctors interviewed, the social
worker or the social nurse takes charge of the administrative process of preparing a SSF
application file. These social workers or social nurses are part of a centralized social
service at hospital following some doctors, this role is taken over by his secretary,
others get the support from the hospitals administration or handle the files completely
on their own. Overall the doctors have little contact with their colleagues from other
disciplines in the hospital on sharing experience with SSF procedures. Most physicians
confer occasionally with colleagues from other hospitals on SSF experiences.
9.12.3 Need for a safety net/relevance of the SSF/effectiveness of the SSF
On the question why the SSF has been established as a safety net next to the regular
health insurance system, the respondents gave three major reasons which they also see
as three major objectives for the SSF:
• To allow new medical treatments not covered by the regular health
insurance system and to reimburse the costs of these. As such the
reimbursement by the SSF is a way to have solidarity at society level for
exceptional individual medical cost of patients that have serious diseases.
The SSF is perceived merely as a technique to limit the costs of new
innovative medical treatments or drugs.
• A way to facilitate the use of new medical treatments, medical devices and
drugs for patient care before all procedures to integrate them in the
regular health insurance are completed.
• A kind of waiting room for new techniques and drugs that allows public
health authorities to get more understanding on relevance and
effectiveness.