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108 Musculoskeletal & Neurological Rehabilitation KCE reports 57 7.71 9.50 K-nom Figure 5.38: Cases and expenditures in the different subsectors 2000 2001 2002 2003 2004 Cases 72.672 85.693 110.610 111.034 120.930 Expenditures (€) 7.785.951 9.613.495 12.029.734 11.557.395 14.269.210 Cases 191.278 222.516 221.051 260.563 251.610 Expenditures (€) 5.453.798 6.510.715 6.738.129 7.904.463 7.881.553 Cases 860.448 972.456 1.003.236 1.139.764 1.237.337 Expenditures (€) 39.369.316 45.025.801 47.306.026 55.888.616 60.475.118 Source: RIZIV/INAMI 2006 Case (as mentioned in the table above) or unit of treatment, is different for the three systems. The figure is therefore only included as an indication, but the different systems cannot be compared. Until 2004, when the system of K-nomenclature was revised, the expense/case was significantly higher for the K-nomenclature than for the 9.50 nomenclature. The reason is not obvious. The expense/case is highest for the 7.71 conventions, in which a lot of highly specialized and intensive rehabilitation is provided. 5.1.10 Comparative analysis of the expenditures in the different systems The comparability of the treatments and prices in the different systems is questionable. Comparing the fixed prices (equivalent of a 1 hour treatment, see table) in the different systems is not as transparent as seems at first. One should take into account that a treatment session can be provided with different intensity, different infrastructure and different multidisciplinary teams. Figure 5.39: treatment expenditures for 7.71 / 9.50 conventions and K nomenclature Locomotor Rehabilitation 771 950 K-nom Centre 1 2 3 4 5 6 7 A2 Baseline (1h) 50 60 40 36 21 21 22 13-39 31 1h 31 2h 101 119 61 3h 153 180 120 109 62 63 66 6h 239 219 117 119 122 Source: RIZIV/INAMI 2006 • Convention 9.50: Expenses refer to the treatment for pathology group A2 after R30/60- the duration of a treatment session is unspecified. Therefore we give a range from 13€ (price/hour in case of 3h treatment) to 39€ (price/hour in case of 1h treatment) as a baseline expenditure. • K-nomenclature: Expenses refer to K30 and K60 • Convention 7.71: Expenses refer to different treatment sessions (full day / half day, maintenance / intensive) and is recalculated to 1h in order to compare with the 9.50 convention and the K nomenclature
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 109 5.1.11 Comparative analysis of the current financing system Table 1 in the Appendix to chapter 5 contains a comparative analysis of the current financial system. Following items are compared: • Price setting • Price per hour of therapy • Duration of therapy sessions • Duration of the rehabilitation program • Items covered by the price • Payment system The comparative analysis is made on the basis of the different pathologies as defined in the different systems, this may be directly, or indirectly by comparability of pathology (e.g. K: Chronic rheumatic progressive joint disease after a clear change in functional autonomy; 9.50: Severe musculoskeletal and psychological impairments due to rheumatoid arthritis in a Steinbrocker stadium III and IV; 7.71: Rheumatoid Arthritis in a Steinbrocker stadium III and IV). It is important to know that per financial system (K, 9.50 or 7.71), the pathologies which are mentioned on their limitative list, are indicated in the table in bold. * Bold = mentioned on the limitative list of this financial system; * Standard = indirectly a candidate for this financial system because of comparability with a pathology that is mentioned on the limitative list. * (Standard) in parentheses = indirectly a candidate for this financial system because of comparability with a pathology that is mentioned on the limitative list, but under certain conditions (See remarks per row). The different financing systems for musculoskeletal and neurological rehabilitation in Belgium that were discussed extensively in the previous sections of this chapter will now be classified according to the typology model by Jegers et al. (2002) 123 . Figure 5.40 summarises the results focusing on the type of reimbursement (fixed or variable and retrospective or prospective). Taking into account the unit of reimbursement, all systems could be classified as more or less variable and prospective. Hence the financial risk is shared by the sponsor and the provider. The incentives are based on combining the unit of reimbursement, the type of reimbursement and the assumption on the height of marginal revenue compared to marginal cost. An arrow up (down) means that the financing mechanism creates incentives to increase (decrease) the respective items. In spite of the fact that a considerable number of financing mechanisms for rehabilitation co-exist in the Belgian context, it is clear from this table that all systems are to a certain degree variable and prospective. Hence, they generate similar incentives : increasing the number of units of reimbursement (e.g. days, sessions, patients) and decreasing the intensitiy of care (and the cost) within the unit of payment. In addition, an incentive for selecting good risks is produced.
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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