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

More documents

Recommendations

Info

222 Musculoskeletal & Neurological Rehabilitation KCE reports 57 • the number of hours per week a rehabilitation specialist is involved • the number of sessions per week of paramedical input (subdivided into individual and group (4 individuals) rehabilitation activities and into the type of discipline involved (e.g. physical therapy, occupational therapy, speech therapy, social work, sports therapy, nursing and psychology). An example of the reference treatment path for THR with polypathology requiring multidisciplinary treatment is presented in Figure 10.2 Figure 10.2: Treatment path for an average patient with THR and polypathology Hospitalization in a rehabilitation centre Number of days 25 Number of weeks 3.6 Medical input hours/week total hours per stay Rehabilitation specialist 0.75 2.7 Paramedical input hours/session number of sessions per week Multidisciplinary treatment 5 20.09 Individual 1 Group sessions (4 patients/group) 0.5 Fractions Physical therapist 60% Occupational therapist 30% Speech therapist 0% Social worker 10% Sports therapist 0% Nurse 0% Psychologist 0% 10.2.1 Calculation of costs total hours per stay Allocating operating costs, depreciations and overhead costs is relatively complicated. Nine different rehabilitation centres were asked to fill in a template in order to provide data on : • Medical and paramedical staff • Operating expenses, depreciations and overhead • Surface area of the rehabilitation centre (inpatient ward and rehabilitation rooms) • Annual activities, i.e. number of sessions K20, K30, K60, M and concention 9.50 Four different rehabilitation centres returned the template: one was incomplete and could not be used for the analysis, three were used to calculate cost. The other
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 223 centres were contacted again in order to know why they did not collaborate. The following reasons were given: anonimity insufficiently guaranteed, data difficult (or almost impossible) to collect, more time (and resources) needed. In a first step total operating costs (excluding wages) and depreciation costs of the rehabilitation centre and general overhead costs were allocated to the inpatient ward and the rehabilitation rooms using their respective surface areas. Then, total annual use of rehabilitation rooms was calculated by adding up the different number of sessions, each multiplied by their respective duration (e.g. 5000 sessions K60 generate 10000 hours). This procedure yields the total number of hours per year that the rehabilitation rooms are used. Dividing operating costs, deprecations and overhead costs allocated to rehabilitation rooms by their annual use (measured in patient hours) leads to an overhead cost ccc per patient hour: 12.44 Euro/hour in centre 1, 15.62 Euro/hour in centre 2 and 25.51 Euro/hour in centre 3. The variables and numbers used in this calculation are reported in Figure 10.3 Figure 10.3: Allocation of overhead costs to a patient hour of rehabilitation in three centres (Euro) Centre 1 Centre 2 Centre 3 Overhead cost rehabilitation centre 1 392 780 1 427 224 1 481 330 Surface area Hospitalization ward 1 806 885 1 836 Surface area rehabilitation rooms 637 847 1 160 Overhead cost allocated to Hospitalization ward 1 029 657 729 365 907 969 Overhead cost allocated to rehabilitation rooms 363 122 697 858 573 361 Activities rehabilitation rooms (total number of hours) 29 194 44 675 22 474 Overhead cost rehabilitation rooms per patient hour 12.44 15.62 25.51 Multiplying these overhead costs per hour by the number of hours of rehabilitation activity according to the protocols yields an allocated overhead cost for every patient in a specific pathology. Depending on the scenario (€ 15/hour, i.e. relatively close to the overhead costs of centre 1 and centre 2 or € 25/hour, i.e. relatively close to the overhead costs of centre 3), allocated overhead costs account for 26%-27% of total costs (scenario 1) or 36%-38% of total costs (scenario 2). Secondly, personnel costs were calculated. Using annual wage cost (seniority of 15 years) for medical and paramedical input and accounting for the number of working hours per year, it is possible to calculate the cost of one hour of medical and paramedical (subdivided into 7 categories) input. This wage cost should also be considered as approximative; it was calculated based on the average of the 3 rehabilitation centres that returned information. It does not take the employment of students or junior doctors, who receive a lower or no wage, into account. The consequence of this approach is that personnel costs may be overestimated. One of the three centres did confirm working with students or assistants. For medical specialists, cost per hour is estimated based on the annual wage cost at a university hospital, where physicians are salaried. It should be noted that in non-university settings physicians are usually self employed. The cost of medical input for the hospital is therefore lower but this cost is not a good representation of the opportunity cost of one hour of medical input. The cost of medical input in a non-university centre underestimates the real opportunity cost. It can be argued that the conditions for using wages of medical specialists at university hospitals as an estimate for opportunity costs are not met, but unfortunately it is the best proxy we have. Therefore, the salary of physicians working in a university setting was considered as the best proxy for the real cost. These annual wage costs and costs per hour (assuming 1626 ddd hours of work per year) are reported ccc In the following tables, the concept ‘overhead costs’ includes operating costs (excluding wages), depreciation and overhead of the rehabilitation centre. ddd Taking into account working hours per week, public holidays, holidays.
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:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186: KCE reports 57 Musculoskeletal & Ne
Page 235: KCE reports 57 Musculoskeletal & Ne
Page 249 and 250: KCE Reporst 57 Musculoskeletal & Ne
Page 275 and 276: KCE Reports 57 Musculoskeletal & Ne
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?