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

More documents

Recommendations

Info

210 Musculoskeletal & Neurological Rehabilitation KCE reports 57 As is the case in the basic variant, both mono- and multidisciplinary approaches can be organised, and services can be offered in inpatient or ambulatory settings. Figure 9.6: Pathology specific trajectory based Stratified Rehabilitation Model acute post-acute chronic 9.2.1.4 Stratified rehabilitation model: Goal oriented Another option is to consider several organizational levels according to the final goal of the rehabilitation: back to work or not (Figure 9.7). It actually refers to one of the principles used in Belgium in the federal “Rijksfonds voor Sociale Reclassering van de Mindervaliden” or former “Fonds Maron”. (see chapter 5) Within the Fund a main distinction was made whether the person to take in charge would be able after the treatment to restart work or not. Figure 9.7: Goal oriented model 1 Stratified Rehabilitation Model Single event (e.g.trauma) Disease based (e.g.stroke) Pathology specific rehabilitation service e.g. MS Pathology specific rehabilitation service e.g. stroke Pathology specific rehabilitation service e.g. SCI General rehabilitation service Rehabilitation: 1 service / province Functional Retraining: General services Back to work ADL, comfort Some elements of this model can be found in the German geriatric rehabilitation model, and –also for the older age groups, in the somatic nursing homes in the Netherlands.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 211 However, one can certainly not say that countries are exclusively orienting their postacute rehabilitation on goal oriented models. 9.2.1.5 Managed Care Rehabilitation Model In a managed care model (Figure 9.8) as currently applied in the U.S., a patient’s health care services utilization is managed by the insurance company. Insurance authorization is needed for some services. The highest level of coverage is only guaranteed for services from providers affiliated with their managed care plan. Some ideas of this model can be found in the German and the Dutch models. Germans are members of sickness funds buying in services and the Dutch model of insurance is also based on a provider-purchaser model. In these countries this managed model is much more embedded in a welfare state logic than in the U.S. (See chapter 8). The principle of contracting health care providers is not applied yet in Belgium and would require a fundamental shift in the health services approach. However, the principles of managed care could also be implemented in Belgium for example by insurers of working accidents or traffic accidents. Figure 9.8: Managed care model for rehabilitation Private insurers e.g. work accidents, traffic accidents Privileged contracts with highly specific Rehab Services Managed care model Insurers Patient populations Inflow criteria for highly specific rehab services and for specific rehab services Privileged contracts with specific Rehab Services 9.2.1.6 Recommended conceptual rehabilitation model The first proposed stratified rehabilitation model in the post-acute phase is considered as the best option. It would require an optimisation of the current informal organisation model of musculoskeletal and neurological rehabilitation in Belgium. Moreover, the principles are comparable to rehabilitation models in the Netherlands, Germany, France and Sweden. The model presented in Figure 9.3 fits best. First, the existing rehabilitation organizations apply for a payment system according to one of the three levels (general, specific, highly specific). Compared to the current Belgian reality we assume that most organisations with a convention 7.71 are comparable to highly specific rehabilitation services. The current situation is far less clear for the specific level. The differentiation between organisations with a convention 9.50 and organisations only reimbursed via Knomenclature is very confuse, due to the important overlap in the patient target groups as well as in the price for the item-of-service. Organisations with a 9.50 convention come closest to the concept of a specific centre, those with nomenclature to general
Page 1 and 2:
Organisation et Financement de la R
Page 3 and 4:
Organisation et financement de la r
Page 5 and 6:
KCE Reports 57B Réadaptation locom
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
KCE Reports 57 Musculoskeletal & Ne
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
KCE reports 57 Musculoskeletal & Ne
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174: KCE reports 57 Musculoskeletal & Ne
Page 223: KCE reports 57 Musculoskeletal & Ne
Page 249 and 250: KCE Reporst 57 Musculoskeletal & Ne
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291:
Page 294 and 295:
Dépôt légal : D/2007/10.273/19
Page 296:
35. Etude relative aux coûts poten
show all

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

Create successful ePaper yourself

Delete template?

Save as template?