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

186 Musculoskeletal & Neurological Rehabilitation KCE reports 57
Health care policy making and organisation.
Health care is provided by a diverse array of entities:
• nonprofit health care provider (generally hospitals) operated by local
or state governments, religious orders, or independent nonprofit
organizations.
• for-profit health care providers (hospitals), which are usually operated
by large private corporations.
There are many outpatient clinics which may be operated by any of the above
organizations or may be a partnership of health care professionals (essentially a large
medical or dental group). There are some health care professionals who individually, or
in a group, practice for personal profit.
The provision and consumption of health and social care, is very much affected by the
health insurance model, and the schedule of benefits it guarantees. Centres for
medicare and Medicaid provide health care services for people falling under respective
categories:
• Health care policy in the USA is based on completely different principles
than the European welfare regimes. Public and private insurance only
covers about 85% of the population.
• Some groups have access to publicly financed programmes: Medicaid
serves the poor, Medicare serves the severely disabled and people above
65.
• Services depend on the type of insurance coverage. There are different
models of health insurance.
• The insurers (of which the federal government is the largest) are the
purchasers of health care services. The provision depends on negotiations.
• Health care is provided by both for profit and non-for profit and public
facilities.
8.7.2 Rehabilitation
8.7.2.1 The underlying conceptual ideas
On the policy level, there is very little explicit conceptual reflection on the content and
organisation of rehabilitation, as the organisational model is generally “left to the
market”. However, some implicit ideas can be found when looking at the different
facilities playing a role in rehabilitation.
8.7.2.2 Rehabilitation facilities
The following settings provide postacute care rehabilitation services:
• Acute inpatient intensive rehabilitation services
• Skilled nursing units (facility with a subacute unit)
• Skilled nursing facility (nursing homes)
• Inpatient rehabilitation facilities
Acute intensive rehabilitation is provided under the general or direct supervision of a
physician and is intended to help the physically or cognitively impaired patient to
achieve or regain his/her maximum potential for mobility, self-care, and independent
living in the shortest possible time. Acute inpatient intensive rehabilitation services are
covered services only when provided to a patient admitted to an acute care bed. It
generally is offered in a section of a hospital which is licensed to provide skilled nursing
services for longer periods of time than the usual hospital stay.