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224 Musculoskeletal & Neurological Rehabilitation KCE reports 57 in Figure 10.4. Concerning the wage cost of the speech therapist it should be noted that for this exercise the cost of a therapist with an “A1” degree was used whereas there are also speech therapist with a university degree. So in the future a possible increase in this cost should be taken into account. Figure 10.4: Annual wage costs and costs per hour of human resources inputs (Euro) Annual cost Cost per hour Medical input Rehabilitation specialist 120 402 74.05 Paramedical input Physical therapist 63.840 39,26 Occupational therapist 49.497 30,44 Speech therapist 49.497 30,44 Psychologist 63.840 39,26 Social worker 49.497 30,44 Sports therapist 63.840 39,26 Nurse 49.497 30,44 Combined with the number of weeks, hours per week and sessions per week specified by the reference rehabilitation path (protocol) total staff costs can be calculated for the selected pathologies and their subgroups. 10.2.2 Calculation of revenues and RIZIV expenditures The theoretical revenues and RIZIV expenses of the centres providing on average rehabilitation services according to the protocols defined by the experts are estimated by applying the current reimbursement mechanisms for musculoskeletal and neurological rehabilitation in Belgium to the rehabilitation protocols of the five pathologies under consideration. Given that different pathologies can be treated within different reimbursement systems (K30/K60 nomenclature, convention 9.50 and/or convention 7.71), three scenarios were built to estimate the range of likely revenues associated with the rehabilitation protocols. Currently, THR can only be reimbursed by means of K30/K60 nomenclature. Moreover, a royal decree for the implementation of a K45-nomenclature for large joint replacement is waiting for publication. A K45 will probably be worth €46.62 and represents a session of 90 minutes. All other pathologies can be treated either by K30/K60 or by a 9.50 convention. With the exception of LEA below knee, all pathologies included in the 9.50 convention can in principle also be treated in a 7.71 centre. We should note that the K30/K60 system is insufficient to finance the entire treatment path as defined by the experts for LEA above knee, SCI, MS and stroke, as more sessions are needed for these pathologies than reimbursed by the K30/K60 system (limited to 60 or 120 sessions depending on the pathology). The revenues are calculated using the full price of the K30/K60 nomenclature, convention 9.50 and convention 7.71. The full price covers the reimbursement tariff and the patient out-of-pocket payment. We used the tariffs that are applicable since January 2007. An overview of the tariffs applied to the five pathologies in the three (or less if some systems are not applicable) reimbursement systems is provided in the Appendix to chapter 10. It should be noted that for some items in the protocol, no precise reimbursement tariff could be identified. For example, if a patient gets one individual session of 2 hours and one group session of 1 hour per day, this can only be charged to the RIZIV/INAMI as one K60 (or R60 in convention 9.50), as centres can charge only one K60 per patient
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 225 per day. No specific reimbursement exists for group sessions. Therefore, group sessions are in principle reimbursed as individual sessions. For example, a group session of 2 hours is charged at one K60 per patient in the group. For pathologies that are treated in a convention 7.71 centre, the number of hours per session became less relevant (from the sponsor’s point of view), in the sense that all hospital sessions are reimbursed through a day lump sum and ambulatory sessions between 1 and 3 h as a half day lump sum and sessions between 4 and 6 hours as a day lump sum. We did have to choose, however, between the tariffs we applied for a half day or day rehabilitation, as the lump sums differ significantly between the 7.71 convention centres. For all pathologies except MS we applied an average lump sum of all centres of €119 per day of hospital treatment, €56 per half day ambulatory treatment and €103 per day ambulatory treatment. For MS, which is particularly treated in 2 specialised centres with higher lump sums, the average lump sum of these 2 centres was used. 10.2.3 Extrapolation to the Belgian population From the unit costs, revenues and expenditures for the protocols of the five pathologies, we estimated the total costs, revenues and RIZIV expenditures for Belgium by means of extrapolation. For the extrapolation, we needed an estimation of the number of patients needing treatment for each selected diagnosis group. This is summarised in Figure 10.5. Figure 10.5: Incidence of multidisciplinary rehabilitation requirements in Belgium for 5 selected pathologies Pathology Incidence Total Hip Replacement 16.599 THR polypathology needing multidisc rehab Hospitalization 830 (5%) THR fragile needing multidisc rehab Hospitalization 1.660 (10%) Lower Extremity Amputation 1.200 LEA below knee needing multidisc rehab Hospitalization 300 (20%) LEA above knee needing multidisc rehab Hospitalization 300 (20%) Ambulatory 300 (20%) Spinal cord Injury 200 SCI (para) needing multidisc rehab Hospitalization 100 (50%) Ambulatory 100 (50%) SCI (tetra) needing multidisc rehab Hospitalization 100 (50%) Ambulatory 100 (50%) MS 10.000 MS needing multidisc rehab Hospitalization 1.000 (10%) MS needing multidisc rehab Ambulatory 1 500 (15%) Stroke 19.000 Stroke patients needing multidisc rehab Hospitalization 2.850 (15%) Ambulatory 2.850 (15%) To calculate these incidences, data from chapter 2 were taken into account. When more information was needed, Belgian experts in the specific field under consideration were contacted and for LEA some RIZIV/INAMI data were used. The incidence of THR in Belgium 46 was 16 599 in 2004. Experts in the field of THR estimated the percentage of fragile patients 10% (mostly the THR due to trauma) and the percentage of patients presenting with polypathology 5%.
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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