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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.