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KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 235
10.3.4 Discussion
rehabilitation. The higher these percentages are, the higher the total costs, revenues
and expenditures will be.
Without giving too much weight to the actual cost figures because these are based on
(incomplete) data from a small number of centres, four major findings can be drawn
from our analyses. Although estimates of costs and revenues should not be used for
policy decision, the merit of the developed methodology is that it reveals certain
weaknesses in the current reimbursement mechanisms for rehabilitation. In the
following paragraphs, explanations for the main findings are sought.
10.3.4.1 Aggregate revenues versus aggregate costs
A first finding is that, for all pathologies taken together, none of the reimbursement
systems (K-nomenclature or conventions) covers the total aggregate costs (last row in
Figure 10.9). Possible reasons for this finding can be related to the methodology used
for calculating costs and revenues (points 1 and 2 hereunder) or to the specific features
of the reimbursement systems (point 3).
Methodological reasons for the difference between costs and revenues might be:
1. Costs are overestimated
The cost estimates are based on the cost structure of 3 rehabilitation centres in
Belgium. This is not a representative sample of the entire rehabilitation supply in
Belgium. Estimates of unit costs, both for personnel and overhead, might be exagerated
relative to the costs of other centres. For example, personnel costs for one hour of
therapy are based on the annual wage cost of a professional therapist and an assumed
number of working hours. The personnel costs presented are hence estimates of the
costs in case no students or assistants would be deployed to do part of the
rehabilitation treatment as defined in the expert-opinion based protocols. If students or
assistants are deployed and if the number of working hours per year is underestimated,
the costs will be lower than the costs presented in this chapter. The impact of
overstimation of personnel costs is important, as personnel costs are about 80% of the
total estimated rehabilitation costs. This applies for all pathologies.
Overestimation of costs might also be due to the use of expert panels consisting of
rehabilitation physicians to develop rehabilitation protocols. These experts may have
overestimated the number of individual sessions and/or underestimated the number of
group sessions in the rehabilitation protocols. If the number of individual sessions is
overestimated or the number of group sessions underestimated, actual costs will be
lower and come closer to the revenues.
2. Revenues are underestimated
The amount of money paid for therapeutic services to patients hospitalised in a Sp-unit
through the day price (“ligdagprijs”) is not included in the calculations of the revenues. It
was impossible to include this in the estimates because no information is available on
the percentage of this amount that can be attributed to the five pathologies under
consideration in case the protocols would be followed. The impact of this exclusion is
that the revenues in all financing systems are underestimated. It is unlikely, however,
that this has a major impact on the estimates, as these amounts are spread over all
patients receiving multidisciplinary rehabilitation in hospital.
Another possible reason for underestimation of revenues, in particular in the K30/K60
system, is omission of the revenues generated by the first “diagnostic” evaluation. This
activity can be charged in the K30/K60-system. The bias generated by this omission is
likely to be small, as the costs of this act were also not included in the cost estimates
for the rehabilitation centre and revenues generated by the act are small compared to
the total revenues generated by the rehabilitation path. The omission of this cost item
will hence have a downward effect on both cost and revenue estimates.