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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.