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246 Musculoskeletal & Neurological Rehabilitation KCE Reports 57 Figure 11.3: Budgets for the stratified rehabilitation model Level 1: highly specialized services MS hospitalization SCI (para) hospitalization SCI (para) ambulatory SCI (tetra) hospitalization SCI (tetra) ambulatory Total cost level 1 hospitalization Total cost level 1 ambulatory Total cost level 1 Level 2: specialized services LEA below knee, hospitalization LEA above knee, hospitalization LEA above knee, ambulatory MS ambulatory Cost covering budgets Budget neutral budgets* 4 339 835 2.468.540 2 732 105 1.554.048 472 858 268.966 4 231 339 2.406.827 639 355 363.672 11 303 278 6.429.416 1 112 213 632.638 12 415 491 (M€12.10 – M€12.67) 7.062.053 (M€5.15 – M€8.60) 847 434 482.029 2 548 053 1.449.358 914 422 520.132 13 365 918 7.602.666 Stroke hospitalization 36 750 132 20.903.836 Stroke ambulatory 29 302 206 16.667.382 Total cost level 2, hospitalization 40 145 620 22.835.223 Total cost level 2, ambulatory 43 582 546 24.790.180 83.728.165 47.625.403 Total cost level 2 (M€71.16 – M€93.88) (M€36 – M€53.89) Level 3: general rehabilitation 49.117.340 27.938.425 services (M€31.85 – M€98.81) (M€21.04 – M€41.39) * obtained by multiplying the share of the costs of the rehabilitation protocol for the pathology in the total extrapollated costs for the entire rehabilitation sector (€145 million) to the budget of 2004.
KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 247 Figure 11.4: Financing mechanisms Stratified Rehabilitation Model: Post-acute Acute Post-Acute Chronic P C S Research & Education Highly Specific Lump Sum or Envelope or Mixed with high weight on lump comp. Specific Lump Sum or Mixed with high weight on lump comp. (e.g.lump sum for coordination and FFS for therapeutic acts) General Multi: FFS (or mixed with high weight on FFS comp.) Mono: FFS Note: the dimension “hospitalized and ambulatory” is not visualized 11.2.3 Options for financing variants of the post-acute stratified rehabilitation model Four variants of the post-acute stratified rehabilitation model were suggested in the previous chapter. The pathology-specific variant focuses on target populations or pathology groups. 11.2.3.1 Pathology specific variant Since the basic level of this variant (general rehabilitation services) is similar to the general level of the stratified model (i.e. relatively low predictability of rehabilitation activities due to an expected high case-mix variability) the suggested financing mechanism is also similar: FFS or a mixed system with a relatively high weight of the FFS component. The second level (pathology specific rehabilitation centres) is characterised by centres treating relatively homogeneous patient groups. Therefore a lump sum or a mixed system with a relatively high weight of the lump sum component can be defended.
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