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

KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 255
reimbursement for travel expenses is only provided for wheelchair bound patients and
only for ambulatory treatment.
A payment system for multidisciplinary follow up of patients with permanent functional
impairments due to musculoskeletal or neurological disorders in the chronic phase,
exists only for a very limited number of pathologies (such as neuromuscular disorders
or cerebral palsy).
The different rehabilitation organizations and Sp-beds are geographically relatively well
spread, even though some corrections seem necessary.
There is no systematic registration of data concerning the performed rehabilitation
activities. There is no accreditation system and only very limited formal quality control.
There is nomenclature for mono-disciplinary physical therapy and speech therapy, but
not for other disciplines such as occupational therapy or psychotherapy.
The RIZIV/INAMI expenditures for (multidisciplinary) musculoskeletal and neurological
rehabilitation accounted for 0.38 % of the Healthcare budget in 2000 and 0.48 % in
2004. In absolute figures the expenditure for musculoskeletal and neurological
rehabilitation grew about 50 % over a five year period, 2000-2004 (from €57.340.095 to
€87.361.509). K-nomenclature and convention 9.50 changed significantly in 2004 and
2006. It is too early to estimate the impact of these changes but there is a trend
towards increased expenses for multidisciplinary K-nomenclature.
Price setting for each unit of payment, as well as per hour of therapy, depends on the
system, is not transparent and mainly based on historical facts.
All financing mechanisms can be qualified as variable and prospective, generating similar
incentives: increasing the number of units of reimbursement and decreasing the intensity
of care (and the cost) within the unit of payment. In addition, an incentive for selecting
good risks is produced.
An international study of five countries has been performed: The Netherlands, France,
Germany, Sweden and the US. Most countries are struggling with the organization of
this sector and are involved in the search for a clear rehabilitation concept comprising
patients’ needs, organizations for the different phases in the trajectory (acute, postacute
and chronic) and continuity of care. Unfortunately, no country disposes of a
ready-for-use model for post-acute rehabilitation. All countries define different levels of
rehabilitation: basic, specialised and highly specialised. For example, SCI rehabilitation is
nearly always assigned to the most specialised level of care, because of the very specific
needs and low incidence.
Several options for organizational models in the post-acute rehabilitation phase are
proposed but the ‘stratified rehabiliation model’ is recommended. This model contains
three levels: general rehabilitation services, specific and highly specific rehabilitation
services, organised in a network. The criteria used for patient assignment to the
appropriate level are: complexity of rehabilitation needs and goals, and incidence and
prevalence of consequences of health conditions. The implementation of this model
requires a systematic assessment of patients’ rehabilitation needs in the acute phase of
the disease trajectory, which has to be repeated periodically and can result in a transfer
of an individual to another level within the network. For this assessment a PCS is
needed, preferably based on the ICF framework. At this point such a PCS is not
available yet and further (international) research is needed in order to develop such a
tool. Awaiting this, several patient data and current assessment measures can be
combined (e.g. medical diagnosis and comorbidities, age, contextual factors and
functional scales such as FIM or Barthel Index). Also, it is mandatory to start as soon as
possible with a central registration system for patient profiles and delivered
rehabilitation activities in order to dispose of real data concerning the needs in Belgium.
As in many other countries, a closed-end budget with a prospective financing system is
preferable if we aim at keeping control over the rehabilitation budget. In an
international context, most financing models try to integrate different components of
financing rehabilitation into a lump sum approach as far as possible. In case a PCS is