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

More documents

Recommendations

Info

52 Special Solidarity Fund KCE Reports 133 The judgements of the labour court are not systematically monitored by the SSF and do not serve as guidelines for decisions on individual cases (personal communication medical directors). This is not so surprising since there’s no continuity and uniformity in the interpretation of some of the eligibility criteria by the courts. The following examples illustrate the divergence of judgements. • Expensive There is no consensus between labor courts about the fact if the personal financial situation of the respective patient has to be taken into account. For instance, the labor court of Antwerp 23 stated that given the social basis inherent to the SSF, the assessment of the term “expensive” has to be related to the financial situation of the patient. The labor court of Gent 24 on the other hand judged that the notion “expensive” has to be set according to objective standards and in function of the treatment and the aim of treatment. • Threatening the vital functions of the patient There is a tendency towards a broader interpretation of this criterion in Jurisprudence. According to the strict interpretation of the Labor Court in 1999 25 , the criterion has to be understood as following: “necessary functions of the human body, such as conscience, respiration, the heart and blood circulation”. 18 Broad interpretations refer to a primordial interest for living or functioning 27 . In that scope psychosocial diseases and quality of life can also be taken into account. 28-30 In the preparatory documents of the law of 2005 the Minister has explicated that a vital function is an essential function such as the sight, even if the disease the patient is suffering from is not life threatening. 31 The labor Court of Antwerp supported this vision in its decision of 10 May 2005 stating that the requirement of the life threatening character of the disease adds a criterion that is not provided in law. 32 • Steps from application to reimbursement The consecutive steps from submitting a request for reimbursement till the final payment of the amount approved by the SSF are summarized the figure below: 18 other court rulings supporting the strict interpretation: Arbh. Gent 10 mei 2002, vijfde kamer, A.R. nr. 2001/164, quoted by J. Diependaele 19; Arbh. Gent (afd. Gent) 14 juni 2004 26
KCE Reports 133 Special Solidarity Fund 53 Figure 3: Consecutive steps of an SSF submission Reimbursment applications related to Epidermolysis bullosa Local sickness fund Local sickness fund Sickness Fund National level After maximum 1 month (+ suspension delay in case of request for additional information) NIHDI Investigation by the ‘College of Medical directors’ + Decision by the ‘College of Medical directors’ (SSF will notify the patient on the nature of the decision) OR Investigation + decision by one member of College of Medical directors/ negative Decisions are contra signed by other member of the College Payment to the patient within maximum 15 working days after decision SSF/20 working days after reception invoice for principle agreement Patient (request for reimbursement) Sickness fund National Level Local sickness fund Receives the decision and communicates the decision and its motivation to the patient Possible appeal to the Labour court
Page 1 and 2:
Optimalisatie van de werkingsproces
Page 3 and 4:
Optimalisatie van de werkingsproces
Page 5 and 6:
KCE reports 133A Bijzonder Solidari
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17:
Page 20 and 21: 2 Special Solidarity Fund KCE Repor
Page 28 and 29: 10 Special Solidarity Fund KCE Repo
Page 118 and 119: 100 Special Solidarity Fund KCE Rep
Page 120 and 121:
102 Special Solidarity Fund KCE Rep
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Wettelijk depot : D/2010/10.273/44
Page 232 and 233:
37. HTA Magnetische Resonantie Beel
Page 234:
108. Tiotropium in de behandeling v
show all

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

Create successful ePaper yourself

Delete template?

Save as template?