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KCE reports 57 Musculoskeletal & Neurological Rehabilitation 9
Introduction
The primary aim of this project was to study the current RIZIV/INAMI (the National
Institute of Sickness and Invalidity Insurance) conventions for “locomotor rehabilitation”.
In the Belgian context, ”convention” refers to an agreement between the RIZIV/INAMI
and a rehabilitation organisation concerning financing of rehabilitation services.
As financing and payment is very much related to organisational issues, the secondary aim
of the study was to assess the organisation and financing of musculoskeletal and
neurological rehabilitation.
Historical developments have lead to an unclear and problematic situation in Belgian
musculoskeletal and neurological rehabilitation. Before 1991 the federal “Rijksfonds voor
Sociale Reclassering van de Mindervaliden” or “Fonds Maron” regulated and financed all
aspects of the rehabilitation facilities. Because of the Belgian political defederalisation this
Fund was replaced by four different Regional Funds (VFSIPH, AWIPH, COCOF,
Dienststelle der Deutschsprachigen Gemeinschaft für Personen mit einer Behinderung
sowie für die besondere soziale Fürsorge). Acute and post-acute rehabilitation remained
incorporated in the federal health care regulation (art. 34 of the law concerning
compulsory health insurance) and rehabilitation services are since then financed by the
RIZIV/INAMI, mainly with a fee for service system.
Rehabilitation activities can be provided within two systems:
• Rehabilitation agreements (“conventions”): different types exist which
will be described extensively in chapter 5.
• Nomenclature of Physical Medicine & Rehabilitation (a fee schedule: “K”;
art. 22 and 23 “Physiotherapy”)
There is a substantial overlap between the different systems and it is not always clear
which system to use. Both systems can be applied to hospitalised as well as ambulatory
patients.
The hospitalisation of these patients is since the early nineties mostly organised in a dayprice
system of specialized beds (Sp beds, S2 musculoskeletal and S3 neurological). These
beds are accredited by the Ministry of Public Health and the “day-price” also covers some
therapists and infrastructure for rehabilitation.
As the organisation and financing of rehabilitation in Belgium is very complex as well as
heterogeneous, different studies have been performed the last five years in order to
describe the actual situation and make recommendations for a reorganisation of the
sector.
• Study by the RIZIV/INAMI (Prof. Heilporn) ordered by Minister F.
Vandenbroucke (October 2000).
• Study ordered by the Advisory Board for Rehabilitation and the college
of Medical Directors of the RIZIV/INAMI, in the context of the Health
dialogues organised by Minister R. Demotte (2003-2004) (Prof.
Heilporn).
• Audit of the Rehabilitation sector performed by the budgetary
commission of the RIZIV/INAMI (June 2004) (P. Verhavert)
• Study ordered by Minister F. Vandenbroucke: Spécificité des services Sp,
Specifieke aspecten van Sp-diensten (2003-2005) (Prof. M-C Closon)
• The study “Réseau de Rééducation et de Réadaptation Locomotrice et
Neurologique” by a Ministerial working group (Prof. Heilporn) in 2005-
2006, ordered by Minister R. Demotte.
However, these reports contain only limited information based on international scientific
literature and data.
For this study two main questions were raised: