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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.