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

KCE Reports 57 Musculoskeletal & Neurological Rehabilitation 263
The KCE report provides epidemiological information which can in a second phase
support the criteria as defined by the Ministerial subgroup.
13.2.4.5 Implementation of the recommendations
The KCE report proposes a four steps scenario for implementation of the
recommendations, the Ministerial subgroup asks for transitional measures during a
period of maximum six months.
13.2.5 Conclusion
The reports of the Ministerial subgroup “Network of musculoskeletal and neurological
rehabilitation” and the KCE project 2005-18 HSR titled “Organisation and Financing of
Musculoskeletal and Neurological Rehabilitation in Belgium” have to be considered as
complementary.
The applied methodology is very different. The Ministerial subgroup report is mainly
based on the current Belgian situation and concrete proposals are based on the input of
the different stakeholders, member of the group. In the KCE project the
recommendations are based on an extensive search of scientific literature, of grey
literature and where necessary completed with national and international expert
opinion, expert meetings and surveys. The approach is more a conceptual one, that can
serve as a basis for further implementation into practise.
Despite the differences between both projects certain common conclusions can be
drawn.
A stratified rehabilitation model is proposed comprising three levels of rehabilitation
services with increasing complexity of the rehabilitation needs. The services part of the
different levels are organised in a network structure. The patient is assigned to the
appropriate level in a particular phase of the rehabilitation trajectory by means of a
patient classification system. The ideal framework for this assessment instrument is ICF.
However, as no such tool is currently available it is by both authors recommended to
start by using a combination of different tools, such as FIM.
The KCE report also comprises analyses of the current financing systems as well as the
proposed systems in the new model. The report of the Ministerial subgroup offers
concrete (minimum) criteria for rehabilitation services on the one hand and
propositions for payment systems for the different pathology groups on the other hand.
The KCE report discusses different options for payment systems at the three levels.
Taking into account both reports, the number of needed services seems to be 3 to 5
for the most specialised level and between 20 and 30 for the second level. For the
basic/general services no number was defined as they can be provided in the acute
hospitals in the current departments of PM&R.
Both studies recommend to (re-)introduce a yearly inspection of rehabilitation services.