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198 Musculoskeletal & Neurological Rehabilitation KCE reports 57 8.8.1.3 Germany 8.8.1.4 Sweden Acute Post acute Chronic insurance Geriatric rehabilitation (age > 70) Specialised, pathology specific, multidisciplinar General, multidisciplinary Rehab centres General, monodisciplinary Rehab centres Nursing homes Home rehab Rehab centres Home rehab Insurance (provider –purchaser)negotiations Acute Post acute Chronic If outside county Highly specialised (pathology) (interregional) Specialised multidisciplinary (county) Hospital units Home care General rehabilitation Rehab centres Rehab centres (municipality) County (provider –purchaser)negotiations
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 199 8.8.1.5 USA, Medicare/Medicaid Acute Post acute Chronic Pre-admission screening insurance •SNF-DP •Acute intensive rehab unit •Skilled nursing units 8.8.2 Summary assessment Specialised, pathology specific, multidisciplinar General, intensive •IRF •SNF The organisation of rehabilitation facilities has to be understood against the background of historical policy choices in organisation, financing and health insurance issues, economic constraints and societal values and preferences of the entire health care system. (Policy-)Reflections on the organisation of the rehabilitation sector, are being linked to conceptual issues about the role of rehabilitation. Policymakers are aware that more clear conceptual delineation of issues related to rehabilitation, is needed to streamline the health care organisation. A well-defined framework for developing trajectories of care and integration of health services is not to be found in the countries studied. Although, it becomes apparent that similar reflections are taking place in order to realise an optimal use of the different kinds of health care services. The debate about organising rehabilitation services is mainly focussing on the clear identification of the roles of services playing a role in acute care and treatment, rehabilitation and long term care. In the different countries similar types of health services are identified as playing a role in rehabilitation. In general terms a distinction is accepted between different types of rehabilitation (related to the purposes and the patients (medical) needs). The important challenge for most countries is now to identify timeslots for each phase and each type of rehabilitation care needed in these time slots. The criteria put forward to define the use of the facilities depend on the local availability of services, the rehabilitation purpose and the medical needs of the patient All the countries studied struggle to translate the different dimensions of rehabilitation targets in organisational facilities. A clear trend is emerging however: rehabilitation policies focus on a clear delineation between the content (and intensity) of rehabilitation, the phases of rehabilitation and the aims of rehabilitation interventions, in order to identify the roles or organisations and providers. Moreover, these roles have
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Dépôt légal : D/2007/10.273/19
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