Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>KCE</strong> Reports 133 Special Solidarity Fund 179<br />
expenses. Most of them are not able to work and have additional<br />
expenses for mobility and housekeeping. They expect the health insurance<br />
system to fully reimburse the costs linked to the disease to the patients.<br />
Two respon<strong>de</strong>nts stress the opinion that reimbursement must be variable<br />
on the income status of the patient; the others don’t see a need for such<br />
an approach.<br />
• The criterion serious diseases is mentioned by five respon<strong>de</strong>nts, rare<br />
diseases by 4 respon<strong>de</strong>nts, not reimbursement within the regular health<br />
insurance system, effectiveness of the treatment, beyond the experimental<br />
phase, no other reimbursement channels, life threatening situation , ad<strong>de</strong>d<br />
value (cost effectiveness) must be proved, scientifically proven.<br />
• As <strong>de</strong>monstrated above, respon<strong>de</strong>nts could only report a limited number<br />
of criteria without the help of the criteria grid. Most respon<strong>de</strong>nts knew a<br />
treatment has to be expensive. One interviewee is convinced that when a<br />
treatment is very expensive, chances on reimbursement are higher. The<br />
other respon<strong>de</strong>nts could not agree with this at all.<br />
The respon<strong>de</strong>nts were asked to formulate their appreciation of each criterion in terms<br />
of rele<strong>van</strong>ce (answering to a real need), clearness and formulation. On this question a<br />
grid in which all criteria were listed was shown to the respon<strong>de</strong>nt. One respon<strong>de</strong>nt said<br />
all elements were too unclear in or<strong>de</strong>r to give an opinion on the rele<strong>van</strong>cy or the<br />
specificity of the formulation. One respon<strong>de</strong>nt did not complete the grid. As a<br />
consequence the overview below is based on eleven responses.<br />
Table 21: evaluation of SSF criteria by the physicians<br />
Clearness Rele<strong>van</strong>t Formulated<br />
sufficiently specific<br />
Yes Neutral No Yes Neutral No Yes Neutral No<br />
Rare indications 7 4 7 1 3 4 2 5<br />
Rare diseases 9 2 8 0 3 6 3 2<br />
Expensive 4 1 6 9 0 2 1 0 10<br />
Related to a rare disease<br />
harming vital functions<br />
Responding to an<br />
8 1 2 6 2 3 6 2 3<br />
indication necessary on<br />
medical – social<br />
perspective<br />
4 1 6 6 2 3 3 2 6<br />
Scientific value and<br />
effectiveness 9 1 1 9 0 2 6 1 4<br />
Passes the experimental<br />
stage<br />
No therapeutic<br />
alternative in the regular<br />
health insurance system<br />
10 0 1 10 0 1 7 0 4<br />
11 0 0 10 0 1 8 0 3<br />
Medical treatments<br />
abroad<br />
10 0 1 9 1 1 8 0 3<br />
Chronically ill children<br />
Costs medical aids en<br />
treatments that are<br />
9 0 3 6 0 5 2 3 6<br />
innovative medical<br />
techniques<br />
7 1 2 9 1 1 6 1 4<br />
NB: the occurrence of the answers is given as an indication but have no statistical signification. No<br />
inference can be done with these results due to the theoretical purposive sample, i.e. not<br />
representative in the statistical acception