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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.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 221 In the LEA group the first subgroup consists of transtibial (below knee (BK)) amputations and the second subgroup of knee disarticulations and transfemoral (above knee (AK)) amputations. The SCI group is divided in function of the level of lesion: paraplegia or tetraplegia. For MS and stroke there are no further subgroups. For LEA subgroup AK, SCI both subgroups, stroke and MS a distinction was made between rehabilitation during hospitalization and ambulatory rehabilitation. For THR only a hospitalization phase was considered. As shown in Figure 10.1, this amounts to 13 distinct categories, of which 8 inpatient and 5 outpatient categories. Figure 10.1: Pathologies considered in the cost, revenues and expenditures analysis Pathology Main Groups Pathology Subgroups THR LEA SCI MS Stroke Polypathology hospitalisation Fragile hospitalisation Above knee hospitalisation ambulatory Below knee hospitalisation Paraplegia Tetraplegia hospitalisation ambulatory hospitalisation ambulatory hospitalisation ambulatory hospitalisation ambulatory Because insufficient evidence on good rehabilitation practice was found in literature, a group of 7 experts was invited to estimate the most optimal rehabilitation path for each of the five pathologies and their subgroups. Information of experts has been used in other studies when little or no other information was available. The experts are physicians specialised in rehabilitation medicine, six of them with a background of physical and rehabilitation medicine and one with a neurology background. They are professionally active in the different Belgian regions (Flanders, Wallonia and Brussels) and in university as well as non-university rehabilitation centres. The experts worked in a very constructive way but insisted unanimously on the fact that a lot of assumptions were made at different levels (duration of therapy, intensity and type of therapy, setting, …) and that the estimations based on the developed “standard” protocols might be very different from the real needs, since to their knowledge little information is available in the literature. Also, according to the stratified rehabilitation model (chapter 9), patients should be referred to different levels of rehabilitation services in function of their rehabilitation needs and goals, as defined by means of a patient classification system (Figure 9.9) (cfr. Chapter 9). The standard protocols as defined by experts consensus only took the pathology into account. However, there seemed to exist a consensus on the protocols as developed during the meeting and summarised by the researchers. The methodology was as follows. First, the experts determined a reference rehabilitation path for an ‘average’ patient. This reference treatment specifies: • the number of weeks treatment is needed
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Dépôt légal : D/2007/10.273/19
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