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KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 239
Key points
• Because of the limited evidence-based literature available on post-acute
rehabilitation, 7 experts were asked to propose a rehabilitation protocol
for an average patient with one of five selected pathologies. Expert opinion
was also used to estimate Belgian incidence of rehabilitation needs per
pathology when no other information was available. Data from 3
rehabilitation centres were used to estimate costs of these rehabilitation
needs. Due to the limitations of this methodology, estimates of costs and
revenues as presented in this chapter should not be used for policy
decisions. The merit of this methodology is that it reveals certain
weaknesses in the current reimbursement mechanisms for rehabilitation.
• For a given rehabilitation protocol for each of the five pathologies
examined, theoretical costs are higher than revenues, except for
ambulatory rehabilitation for MS in convention 7.71. The exception for MS
can be explained by the specific reimbursement conditions of the two 7.71
centres specialized in MS (higher lump sum than other 7.71 centres and no
separate tariff for sessions of less than 3 hours) and the long duration of
ambulatory rehabilitation in this patient group.
• Aggregate revenues for ambulatory rehabilitation in Belgium are higher
than for hospital rehabilitation. This relationship was not found for the
costs of ambulatory rehabilitation and hospital rehabilitation. This pointed
towards an artefact in the estimates of the revenues caused by the rules of
the current financing system. More specifically, the absence of a separate
tariff for group sessions induces higher revenues than costs for group
sessions.
• Aggregate revenues for rehabilitation services in each of the
reimbursement systems are insufficient to cover theoretical aggregate
costs. This can be explained by methodological weaknesses of the study
(overestimated costs or underestimated revenues) and/or to the fact that
the current reimbursement system does not reflect the cost structure of
rehabilitation services. The real difference between costs and revenues will
moreover depend on the actual case-mix.
• One illustration of this inadequate reflection of the cost structure in
current reimbursement rules is the reimbursement of a maximum of 2
hours of treatment per day in the K-nomenclature and convention 9.50.
For some pathologies (especially during the initial phase of rehabilitation,
see the proposed protocols during hospitalization) more than 2 hours of
treatment per day is needed.
• The limited number of sessions and the limited duration of sessions in the
K-nomenclature is insufficient to cover the therapeutic needs of patients
with very complex rehabilitation needs, such as spinal cord injury.
• The budget spent to musculoskeletal and neurological rehabilitation in
2004 highly resembles the estimates for aggregate expenditures if all
rehabilitation protocols would be followed and if all activities would be
reimbursed through convention 9.50. On the one hand, this may mean
that the optimal rehabilitation paths are currently followed on average,
although there might also be discrepancies between pathologies that level
each other out. On the other hand, this may mean that the protocols are
based on current practices rather than on rehabilitation needs.