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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 181
facilities. The counties counter that municipalities are not providing enough elderly or
long-stay beds and claim that one in ten hospital beds is still occupied by someone who
is medically ready to be discharged and who should be treated in primary care or at
home. In 2004, a committee delivered recommendations on improving the boundary
between health and social care, and proposed putting a greater responsibility on
municipalities to provide integrated social and health care while giving them the ability
to hire their own doctors if they feel that the counties are not allocating enough
physician time to municipal home care (SOU, 2004).
8.6.2.3 Financing rehabilitation
The financing of the post-acute stroke rehabilitation centres is organised in a fixed
budget system. (contrary to the acute sector that is financed on a DRG-system).
Purchaser-provider negotiation decide on the amount of care there will be offered for
the budget. The budget includes infrastructure; e.g hospital beds, cleaning etc, staffing,
extra examinations (such as a new MR examination), training equipment for use at the
hospital.
Specifically for rehabilitation, a Nordic European pilot study (in which Swedish teams
participate) aims at integrating functional status measures based on ICD-10 coding,
(including a critical analysis of ICF, FIM, FRG, AN-SNAP). The project aims at
developing a method to measure activity and participation of the patient on special care.
But a real wide scale implementation of the ICF is not realised yet. For ICF to become
used more widely there is a consensus that more developed guidelines are needed as a
complement to the classification.
There Nordic work group is also developing reflections on how to link between acute
inpatient care and rehabilitation and will develop a proposal for rehabilitation in 2007.
There is yet no link with the current NordDRG systemoo..
8.6.3 Quality
The National Board of Health and Welfare issued a set of regulations on quality issues
for all health services to develop continuous quality improvement. The regulations
emphasize on monitoring and quality-improvement measures focusing on technical
quality and safety and issues related to the people for whom health services are
intended.
The National Quality Registers are used as supportive tools for analyses of the medical
quality and outcomes in specific parts of the healthcare system. The national quality
registers mainly cover highly specialised care provided at hospitals, whilst primary health
care largely lacks joint follow-up systems. Standardised patient questionnaires are used
and Safety problems and shortcomings in care are registered, e.g. by the Medical
Responsibility Board, Patient Insurance Fund, and in the National Board's Risk Database.
Data from National Health Data Registers can be used to monitor health care
utilisation, morbidity and mortality on a population level. Some 40 national health care
quality registers, are developed each containing data on health care outcomes and
treatment for a large number of categories of illness. These registers serve as a
190, 191
knowledge base for continuous improvement.
Although the prerequisites for monitoring the quality of care in Sweden are good,
further development of models and methods for performance assessment are needed.
Sweden has for instance no databases and quality indicators in primary care and care for
many chronic diseases and psychiatric disorders. Hence, the quality of services cannot
be defined for a large proportion of health services delivered.
In 2001, the National Board of Health and Welfare, jointly with the Federation of
Swedish County Councils and the Swedish Association of Local Authorities started a
reflection on a comprehensive and coherent system for review and for exchanging and
maintaining information within treatment and care. Part of the exercise also focussed on
oo www.nordclass.uu.se/verksam/norddrge.htm