The report is available in English with a French summary - KCE

250 Musculoskeletal & Neurological Rehabilitation KCE Reports 57
11.2.3.2 Function specific variant
Variant 2 of the organisational models differentiates reference centres based on
“functional” impairment. Regarding a possible financing mechanism for this variant, the
characteristics of both levels are similar to those of the previous variant. Consequently
the suggested mechanisms are identical: FFS or a mixed system with a relatively high
weight of the FFS component for the general rehabilitation services and a lump sum or a
mixed system with a relatively high weight of the lump sum component for the
reference centres.
Since in Belgium no information is available on rehabilitation patients at the functional
level, and since for the 5 selected pathologies the subdivision according to functional
impairment is not known, budget allocation cannot be specified.
11.2.3.3 Pathology specific trajectory based rehabilitation model
The 3 rd variant presented in chapter 9, is the trajectory based model in which centres
treat certain pathologies during the whole trajectory of care, namely acute, post-acute
and chronic phase. Since the “general rehabilitation services” level of this variant has
characteristics similar to those of the general level of the stratified model, the suggested
financing mechanism for this level (with high case-mix variability) is FFS of a mixed
system with a relatively high weight of the FFS component. The pathology specific
rehabilitation centres will treat relatively homogeneous groups of patients, therefore a
lump sum or a mixed system with a relatively high weight of the lump sum component
is suggested.
The protocol proposed for the 5 pathologies was limited to the post-acute phase, and
did not include the acute and chronic phase. Budget allocation for the subacute phase
equals variant 1.
11.2.3.4 Goal oriented model
The goal-oriented model (variant 4) is based on the final goal the patient should attain:
back to work or not. Depending on the homogeneity of patient groups the payment
mechanism could be rather lump sum (in case of relatively homogenous patient groups)
or rather fee for service (in case of relatively heterogeneous patient groups) oriented.
The proportion of patients in the 5 pathologies for which this goal possibly can be
reached is unknown.
11.2.3.5 Managed care model
The last model (managed care model) emphasizes the role insurers can play in
negotiating prices with providers. Insurance companies and sickness funds bargain with
providers over volume, prices, quality and numerous other stipulations. Hence, the
budget is determined by these negotiations.
Key points
• Every payment mechanism has advantaged and disadvantages and may
generate perverse incentives.
• FFS, lump sum and a mixed system were discussed.
• For the proposed organisational rehabilitation models, the general level is
characterised by a relatively high case-mix variability. A reimbursement by
a FFS or a mixed system with relatively high weight on the FFS
component seems most appropriate for this level.
• For levels treating more homogeneous patient groups (specific or highly
specific level, pathology specific level, function specific level, pathology
specific centres) a mixed system with a relatively high weight on the lump
sum or a fixed budget for the rehabilitation centre (envelope) seems
appropriate.