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

18 Special Solidarity Fund KCE Reports 133
3.2 EVALUATION OF THE FUNCTIONING OF THE SSF
The second research question, linked to the evaluation of the functioning of the SSF has
been divided in 3 sub-questions which are stipulated below:
• What are the explicit and implicit criteria for assessment of eligibility of
items and how are they interpreted?
• Is the SSF known among patients, prescribing doctors, hospital social
services and the pharmaceutical industry? What are the information
channels through which they get informed about the existence of the SSF?
• How is the application procedure and decision-making process evaluated
by all parties concerned (e.g. clarity of criteria, duration, “customer”
friendliness)?
The purpose of these questions is to make a critical assessment of the procedural and
the substantive processes of the SSF based on stakeholders perception and quantitative
analysis of the SSF database sample. External stakeholders include “medical specialists
making use of the SSF”, “hospital social services” and patient organizations playing an
important role as information providers and/or application initiators toward the
potential beneficiaries (patients). The pharmaceutical industry is also an external
stakeholder via their link with the treating medical doctors (prescribers), the patient
(provision of drugs) and the NIHDI (reimbursement of orphan drugs). The medical
directors of the health insurance funds are as well internal stakeholders (members of
the decision-making body of the SSF) as external stakeholders (every application of a
potential beneficiary patient needs to be introduced via his/her health insurance fund to
the SSF. In the methodology section the different stakeholders are described in detail.
3.3 EXPLORATION OF (COMPARABLE) SAFETY NETS IN A
SELECTION OF FOREIGN COUNTRIES
The purpose of the third research question is “what lessons can be learned from a
selection of foreign countries?” In order to answer this question 2 sub-questions are
addressed:
• Do comparable safety nets for rare diseases exist in a selection of foreign
countries and how do they function?
• How is the care of selected cases of the targeted SSF population
organized in the selected countries?