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114 Musculoskeletal & Neurological Rehabilitation KCE reports 57 The mix of the different types of rehabilitation centres guarantees a range from very general to highly specialised treatment in the Belgian rehabilitation landscape. However, due to a lack of formalised coordination and patient classification system with criteria for referral between the different levels of rehabilitation and a good description of the roles and tasks of all types of rehabilitation, the system lacks transparency. Key points • The organisation and financing of musculoskeletal and neurological rehabilitation in Belgium lacks transparency and clinical coherence. • Several parallel payment systems exist but are mostly based on historical factors rather than on criteria related to patients’ rehabilitation needs and goals. • One payment system is linked to hospital stay with specialised beds (Sp beds) for diagnosis and treatment of musculoskeletal (S2) and neurological disorders (S3). • Other systems are linked to rehabilitation activities and concern mainly nomenclature (K, M and R) and rehabilitation agreements (also called conventions). These systems are mainly fee for service systems. • Several combinations (parallel as well as sequentially) of the different payment systems are possible, inducing a very heterogeneous rehabilitation landscape in Belgium. • The different payment systems overlap significantly. • There are no clear criteria for patient referral to the different types of rehabilitation organisations and the only characteristic on the limitative lists is the medical diagnosis. • There are no criteria justifying an inpatient treatment. • Patients’ rehabilitation needs and goals are not formally assessed. • Sp-beds are financed on a 7/7 days basis, discouraging week-ends home. Neither is there reimbursement for travel expenses for week-ends home (see further: transport convention). • There is no systematic registration of data concerning the performed rehabilitation activities. • There is no accreditation system and only very limited formal quality control. • The different rehabilitation organisations are geographically relatively well spread, but there is no convention in the province of Luxemburg. The number of conventions, corrected for population density is high in the region of Brussels capital and West Flanders. The number of Sp beds (S2 and S3) is relatively low in the provinces of East Flanders and Namur. • There is nomenclature for mono-disciplinary physical therapy and speech therapy, but not for other disciplines such as occupational therapy or psychotherapy. • Reimbursement for travel expenses is only provided for wheelchair bound patients and only for ambulatory treatment. • The RIZIV/INAMI expenditures for (multidisciplinary) musculoskeletal and neurological rehabilitation were 0.38 % in 2000 and 0.48 % in 2004. • In absolute figures the expenditure for musculoskeletal and neurological rehabilitation grew about 50 % over a five year period, 2000-2004.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 115 • K-nomenclature and convention 9.50 changed significantly in 2004 and 2006. It is too early to estimate the impact of these changes but there is a trend towards increased expenses for multidisciplinary K-nomenclature. • A payment system for follow up of patients with permanent functional impairments due to musculoskeletal or neurological disorders in the chronic phase, exists only for a very limited number of pathologies (such as neuromuscular disorders). • Price setting for each unit of payment, as well as per hour of therapy depends on the system, is not transparent and mainly based on historical facts. • Within the convention 7.71 the reimbursement per hour for organisations with ambulatory treatment only is higher than for some organisations with hospitalisation. • All financing mechanisms can be qualified as variable and prospective, generating similar incentives : increasing the number of units of reimbursement 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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