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

34 Special Solidarity Fund KCE Reports 133
The total number of patients reimbursed by the SSF decreased drastically from 1.609
patients in 2004 towards 637 patients in 2008.
The decrease in number of patients in the category “implants” and “medical treatments”
explains the overall decrease in number of patients.
Table 5: Number of patients per type of treatment 2004-2008
Agreements Number of patients (1)
2004 2005 2006 2007 2008
M edicines 502 358 337 384 435
Im plants 713 704 363 126 85
Instrum ents, prothesis, orthesis 45 38 54 44 37
Food for particular nutrition uses 13 19 22 6 9
P ractictioner's fees 0 0 2 1 5
M edical Techniques 319 151 110 81 35
O intm ents, medicines, bandages… for skin diseases 14 15 17 21 15
B andages, tam pons, protection m aterial… 3 2 8 5 4
Following a treatment plan 0 2 9 14 12
Total 1.609 1.289 922 682 637
Source: Annual reports of the Special Solidarity Fund 2004, 2005, 2006, 2007, 2008
The average amount spent per category and per patient is high for “medicines”,
“ointments-medicines and bandages for skin diseases”.
Between 2004 and 2007 the average amount spent per patient increased from €9.288
to €16.347 and decreased to €13.722 in 2008.
A possible explanation for the different rate in decline of number of applications
compared to number of patients, is that in more recent years, the number of renewals
have increased compared to the number of new applications.
Table 6: Average amount of reimbursement per patient per type of
treatment 2004-2008
Agreements
Average amount of reimbursement / patiënt
(2004-2008)
2004 2005 2006 2007 2008
Medicines 25.768 14.915 23.834 28.593 18.322
Implants 1.320 1.359 1.531 1.931 3.595
Instruments, prothesis, orthesis 2.758 6.027 2.508 3.194 3.145
Food for particular nutrition uses 1.914 12.054 1.239 1.751 2.038
Practictioner's fees 0 0 3721 107 1.068
Medical Techniques 1.626 1.211 1.410 845 1.420
Ointments, medicines, bandages… for skin diseases 28.269 22.196 30.057 15.432 16.069
Bandages, tampons, protection material… 1.499 840 1.240 3.184 674
Following a treatment plan 0 3.188 813 1.573 2.669
Total 9.288 5.487 10.240 16.347 13.722
Source: Annual reports of the Special Solidarity Fund 2004, 2005, 2006, 2007, 2008
As the SSF determines itself what part of the costs are reimbursed, differences are
observed in the SSF sample between the amount of reimbursed asked and granted. This
difference seems to be associated with the type of treatment applied for (see figure 2).
In particular for drug treatments, most applications are reimbursed up to a certain
amount: 41.6% of applications at 75% reimbursement, 13.8% at 85% reimbursement, and
13.3% at 60% reimbursement. In contrast, 20.8% of drug treatment applications are fully
reimbursed. Similarly, 19.4% of special diet are fully reimbursed, while 35.2% are
reimbursed at 75%, and 24.4% at 78%.