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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.