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220 Musculoskeletal & Neurological Rehabilitation KCE reports 57
10 COSTS, REVENUES AND RIZIV/INAMI
EXPENDITURES FOR POST-ACUTE
MUSCULOSKELETAL AND NEUROLOGICAL
REHABILITATION
10.1 INTRODUCTION
In this chapter, we explore the possibility of calculating costs and revenues of five
relevant pathologies. The analysis is based on the five pathologies selected in chapter 2
and examined in chapter 6 and 7.
Because of the limited evidence-based literature available on post-acute rehabilitation, 7
experts were asked to propose a rehabilitation protocol for an average patient with
one of the five selected pathologies and some sungroups. Expert opinion was also used
to estimate Belgian incidence of rehabilitation needs per pathology when no other
information was available.
It should be stressed that these proposed rehabilitation protocols are subjective
estimates and not scientifically proven to be “ideal”: e.g. the experts’ estimates of the
average duration or average number of sessions per week showed a large variation.
However, the methodology has also been used in a recent part of the HealthBASKET
study by the European Commission 239 , in case no other possibilities were available to
estimate costs and revenues.
Consequently, estimates of costs and revenues as presented in this chapter and in the
following chapter should not be interpreted as precise estimates of costs and revenues
in the actual situation, with the current rehabilitation practices, nor of the precise costs
of the standard rehabilitation protocols as defined by the experts. More precise
estimates would require data from more rehabilitation centres (cf infra) and better data
on the multidisciplinary rehabilitation activities in the five selected pathologies. The
methodology does illustrate, however, some possible weaknesses of the current
reimbursement system for rehabilitation and its possible effects in terms of generating
discrepancies between costs and revenues. The protocols are examples of –according
to the experts- rehabilitation requirements for an ‘average’ patient. For these
rehabilitation paths, costs and revenues under the current reimbursement system are
calculated. The figures will not be indicative of the actual costs, revenues and
RIZIV/INAMI expenditures to be expected in practice but give an indication of the
order of magnitude of costs, revenues and expenditures for these protocols. From this,
inferences are made about the likely effects of the current reimbursement system.
Policy decision should not be based on the actual value of the estimates.
10.2 METHODS
In this chapter we calculate costs, rehabilitation centre revenues and RIZIV/INAMI
expenditures for the post-acute phase of the following pathologies (already examined in
previous chapters): total hip replacement (THR), amputation of a lower extremity with
prosthesis (LEA), spinal cord injury (SCI), stroke and multiple sclerosis (MS), THR, LEA
and SCI were further subdivided into subgroups.
For THR two subgroups were made in the post-acute phase. The assumption is that the
“standard” THR patient can be helped with (monodisciplinary) treatment in the acute
phase. The first subgroup in the post-acute phase comprises patients presenting with
“polypathology”. Polypathology refers to pathology with clear functional impairments
such as stroke, polyneuropathy, Parkinson's disease or rheumatoid arthritis. The second
subgroup are the “fragile” patients needing a more extensive multidisciplinary treatment
than provided by the standard THR rehabilitation protocol. Mostly this group consists
of trauma patients.