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

262 Musculoskeletal & Neurological Rehabilitation KCE reports 57
13.2.4.2 Financial models
For each rehabilitation level in the network, recommendations are made for an
appropriate payment system. However, there are some significant differences in the
recommendations between both reports.
In the Ministerial subgroup the recommendations concerning organisation and financing
are based on the actual payment systems (Nomenclature PM&R and Conventions)
whereas the KCE research team discusses several theoretical options.
The proposed payment systems are shown in the next table.
Ministerial subgroup KCE study
General/Basic existing K-nomenclature (K30/K60,
with for some pathologies a change in
maximum number of sessions from 60
to 75)
Specific/LRC a new R-nomenclature (R1 for 2 hours
and R2 for 3 hours of treatment)
fee for service (FFS) or mixed with
high weight on FFS component
lump sum or mixed with high weight on
lump component
Highly spec./CRC lump sum per day of treatment envelope or lump sum or mixed with
high weight on lump component
The KCE study comprises a detailed analysis of the current organisation and financing of
musculoskeletal and neurological rehabilitation with budgetary data in the period 2000-
2004, as well as a cost and expenditures calculation based on the estimated needs in the
post-acute rehabilitation phase taking into account the developed stratified
rehabilitation model, the epidemiological data on the five studied pathologies, and the
‘standard rehabilitation protocols’ developed for these pathologies by an expert group.
13.2.4.3 Number of services needed in Belgium
In the KCE study an attempt was made, based on literature data, to estimate the
number of needed rehabilitation services at the different levels, for the five studied
pathologies. These data were also used for the calculation of the estimated
expenditures in the proposed financial model.
Both reports propose to supply basic/general rehabilitation in the departments of
PM&R, present in most of the acute hospitals.
The number of rehabilitation services of the second level is estimated in by the KCE
team as (maximal) 20 to 30 and in the Ministerial subgroup report 23 for stroke, or
about 30 for the whole of the musculoskeletal and neurological rehabilitation. This is
very similar, although there are some differences between the 2 studies in the
subgroups of patients assigned to this level. However, centres can be larger or smaller
and should be geographically well spread.
The report of Prof. dr. Heilporn mentions no estimations for the number of needed
CRC and prefers to wait for the results of the KCE study. In the KCE report 3 to 5
highly specific centres are recommended, combining different pathology groups.
13.2.4.4 Quality and control
Both reports stress the importance of quality control.
The KCE report contains information on how quality control and accreditation is dealt
with in the five studied countries, and proposes to restart evaluations of the
rehabilitation organisations by a visitation committee.
The Ministerial subgroup proposes a yearly activity report for the locoregional and
categorical rehabilitation services, as well as a yearly inspection of these LRC and CRC.
For basic services (PM&R) no control system is proposed, whereas a lot of patients are
assigned to this level.
The Ministerial subgroup also defines concrete (minimum) criteria for the LRC and
CRC, based on the current situation and on expert opinion.