The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 113
• The geographical distribution of 9.50 and 7.71 conventions is relatively
homogeneous in Belgium. Only the province of Luxembourg lacks a
convention, and Brussels as well as West Flanders have a higher
number of conventions, even corrected for number of inhabitants.
• Travelling expenses represent 11 % of the total expenditures linked to
the 7.71 convention, 33 % of the total expenditures linked to the 9.50
conventions and is therefore not negligible. It is included in the
convention 9.50 and 7.71 expenditures as discussed in the paragraphs
below.
• The expenditures of the musculoskeletal and neurological
rehabilitation sector as calculated in paragraph 5.1.9, are probably
underestimated. Because there is no link between the Mnomenclature,
R-nomenclature and their specific segment of
musculoskeletal and neurological rehabilitation treatments it is not
possible to allocate this part of the expenses.
• Total expenditure of musculoskeletal and neurological rehabilitation
2000-2004 is mainly explained by the K nomenclature (+/-68%), the
7.71 conventions (+/-18 %) and to a lesser extent by the 9.50
conventions (+/-14%).
• In the period 2000 – 2004 we noticed an expenditures growth (travel
expenses included) of 52 % for musculoskeletal rehabilitation. In
absolute data (€) this growth is mainly caused by the K-nomenclature
(70%), but also the 7.71 conventions (20%) and the 9.50 conventions
(10%).
• Looking at the three subsectors separately, there is a percentage
growth of 50% for the K nomenclature, 45 % for the 9.50 conventions
and 83 % for the 7.71 conventions.
• As shown in paragraph 5.1.10, the prices for each unit of payment, as
well as per hour of therapy are very variable depending on the system.
• No link was identified between cost models and treatment. In general
the only criteria used are the duration and total number of sessions,
the target groups and some limited team requirements.
• As shown in Table 1 (see Appendix) (comparative analysis), the
overlap in pathologies between the different systems (convention 9.50,
convention 7.71 and K nomenclature), indicates that there is no clear
mandate for the different subsectors. Most of the patients and
pathologies (except for three pathologies from the limitative K30/60
list) can be treated in the three different systems. This has implications
for the expenditures per treatment, the expertise of the team and the
maximum number of treatments. This is changing August 1st 2006,
with the application of the “new” 9.50 convention and the creation of
a R30/60. A centre with a 9.50 convention can no longer use K30/60
for the patients included in the convention. In exchange an R30/60 has
been created with the same conditions as K30/60. This should limit
overlap and clarify the situation.
• No clear criteria for patient referral exist (patient classification
system), which worsens the overlap situation. A referral system based
on clinical criteria could increase the transparency of the system.
• Indicators such as severity, complexity, age, co-morbidity,
rehabilitation needs and goals, etc. are not included in the cost model.
• Except for the inspection visits controlling quality in Sp services (in
Flanders), there are no other explicit quality or accreditation systems
in musculoskeletal rehabilitation in Belgium.