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230 Musculoskeletal & Neurological Rehabilitation KCE reports 57 THR Figure 10.8: Revenues and RIZIV expenses of standard rehabilitation protocols for five selected pathologies under current reimbursement rules (Euro) Pathology Setting Centre revenues per treatment protocol (total treatment period) according to current reimbursement mechanisms K30/K60 Convention 9.50 Convention 7.71 K30/K60 THR polypathology Hospitalization 1 119 1 007 THR Fragile Hospitalization 311 280 LEA RIZIV expenses per treatment protocol (total treatment period) according to current reimbursement mechanisms LEA BK Hospitalization 1 368 1 368 1 231 1 231 Convention 9.50 Convention 7.71 LEA AK Hospitalization 3 419 3 419 6 545 3 077 3 077 6 545 SCI Total costs borne by centres applying the protocol Ambulatory 311 885 1 120 280 832 1 090 3 048 SCI (para) Hospitalization 7 459 8 159 16 303 6 714 7 414 16 303 Ambulatory 0 2 469 3 360 0 2 378 3 269 4 729 SCI (tetra) Hospitalization 7 459 11 327 25 466 6 714 10 582 25 466 42 313 MS Ambulatory 168 3 377 4 368 168 3 259 4 250 6 394 MS Hospitalization 1 368 1 368 3 663 1 231 1 231 3 663 4 340 MS Ambulatory 3 264 6 682 11 440 2 960 6 038 11 283 8 911 Stroke Stroke Hospitalization 5 470 5 470 10 472 4 924 4 924 10 472 12 895 Ambulatory 2 492 6 113 6 720 2 293 5 781 6 539 10 281 1 258 352 2 825 8 494 27 321
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 231 10.3.3 Extrapolation of costs, revenues and expenditures to the entire rehabilitation population in Belgium Figure 10.9 presents the results of the extrapolation of the theoretical costs, revenues and expenditures per treatment protocol to the entire patient population in need of multidisciplinary rehabilitation services in Belgium. The five pathologies were assumed to account for 75% of hospital post-acute rehabilitation and 60% of ambulatory rehabilitation (see 10.3.3). For revenues and expenditures again three scenarios are presented, one for each possible financing system. A scenario gives the results of a situation where all services for all pathologies are financed through one specific financing system, either K30/K60, convention 9.50 or convention 7.71. For example, the revenues and expenditures in the convention 9.50 scenario are the revenues and expenditures obtained if all treatments of all patients with the pathology are reimbursed within a convention 9.50. In reality a mix of the three systems exists but as we have no data on the proportion of treatments for each of the pathologies reimbursed through the different financing systems, we could not simulate the actual revenues and expenditures if everyone would follow the protocols. Note that the total expenditures presented for convention 9.50 and 7.71 (last row in the table) are incomplete. They do not cover the reimbursement of rehabilitation services for THR, as this pathology cannot be reimbursed through one of these conventions. Likewise, rehabilitation for LEA below knee cannot be financed through convention 7.71. For K30/K60 nomenclature, the current reimbursement rules preclude full reimbursement of some rehabilitation protocols. That is the reason why, for instance, the expenditures for SCI (paraplegia) ambulatory are zero. According to the protocols, the maximum number of treatment sessions allowed for this condition (120) is already needed during the period of hospitalization. As a consequence, there is no reimbursement left for ambulatory sessions according to the current reimbursement rules. This incompleteness for all scenarios implies that the total estimated expenditures and revenues are lower than the actual revenues and expenditures respectively associated with the rehabilitation protocols. The difference with the total centres’ costs (added in the last column of the table for comparative purposes) will therefore be less pronounced in reality than in this theoretical exercise.
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