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242 Musculoskeletal & Neurological Rehabilitation KCE Reports 57 Total payment 4000 3500 3000 2500 2000 1500 1000 500 that providers are not strongly encouraged to supply a sufficient amount of care to their patients. 0 Figure 11.1: Total payment Lump Sum FFS Mixed (a=25%) Mixed (a=80%) 0 10 20 30 40 50 60 70 80 90 100 110 120 Volume
KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 243 Marginal payment 35 30 25 20 15 10 5 0 Figure 11.2: Marginal payment Lump Sum FFS Mixed (a=25%) Mixed (a=80%) 0 10 20 30 40 50 60 70 80 90 100 110 120 11.2.1.4 Variants of units of payment Volume The classification of a payment as lump sum or FFS also depends on the unit of payment (e.g. a fee per discharge, per episode, per year, capitation payment… (see chapter 5)) 11.2.2 Options for financing of the stratified rehabilitation model For the stratified rehabilitation model (see 9.2.1.1) several options for reimbursement will be discussed. For each level, two budgets will be calculated: (1) the budget that would be required to cover all costs of the centres offering rehabilitation services (assuming that the treatment protocols presented in the previous chapter are on average followed) and (2) the budget that corresponds with the amount the RIZIV/INAMI could spend on the three levels if it works with a fixed budget of €82 625 881 (i.e. the budget spent in 2004)(see chapter 5) for musculoskeletal and neurological rehabilitation (i.e. budget-neutral resources) The starting point is a stratified model with the five studied pathologies attributed as follows: hospital rehabilitation for MS and hospital and ambulatory rehabilitation for SCI in the highly specific level, ambulatory rehabilitation for MS, hospital and ambulatory rehabilitation for stroke and LEA in the specific level, THR in the general level. (The general level consists of pathologies requiring only monodisciplinary or simple multidisciplinary rehabilitation services, such as THR, recovering strokes and a number of orthopaedic cases like shoulder rehabilitation, chronic back pain,…). For the calculation of the budget to be allocated to the different levels of the stratified organisation model under the restriction of total-budget neutrality, it is assumed that the share of the pathology in the 2004 budget is equal to the share of the pathology costs in the total costs for the entire population if the rehabilitation protocols would be followed, as calcualted in Figure 10.9. One reimbursement option is a uniform financing system for all levels within the stratified model. However, differences in complexity (higher in the (highly) specific level) and predictability (lower in the general level due to higher variability in case-mix) of rehabilitation activities, favour differentiation in financing mechanisms, as is shown in Figure 11.4.
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