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60 Musculoskeletal & Neurological Rehabilitation KCE reports 57 Figure 5.4: Typology of the Belgian payment system for rehabilitation Typology of the Belgian payment Micro Macro 5.1.2.1 Hospital stay system for rehabilitation Closed-end Open-end Fixed Variable Prospective Retrospective Hospital stay Therapy In Belgium the payment of services related to a hospital stay is done via a hospital funding system, which can be classified as a closed-end budget with a ‘hard cap’ at the governmental level. For the description of the coverage by the hospital day price we refer to “De Belgische ziekenhuisfinanciering ontcijferd. Walter Sermeus. ISBN 90-334-5277-4”. There is no link between the price and the real costs related to the delivered services during a hospital stay. Hence, funding of the stay component in Belgian hospitals can, at the microlevel, be classified as a prospective, variable payment system. The main parts in the hospital day price are B1 (financing of general services) and B2 (financing of clinical services), which represent 85% of the budget. For acute services B1 is yearly calculated related to units of work and B2 is yearly calculated related to justified activity. For organisations providing musculoskeletal and neurological rehabilitation a specific system exists (Specialized or Sp-beds) where B1 and B2 are not recalculated every year, but set at their historical price level, annually adjusted for inflation. Historical prices depend on the history of the beds in these organisations. l Within the group of Sp-beds it concerns S2 beds for hospital stays during specialised musculoskeletal rehabilitation and S3 beds for specialised neurological rehabilitation. These beds can issue from beds for chronic care (V bed), for psychogeriatric care (Vp bed), for specialised rehabilitation (S bed), for surgical interventions (C bed), for acute medical services (D bed) or for the treatment of multiple sclerosis and its consequences (H bed). The historical price is higher for acute (C and D) beds than for V and S beds. The budget to which an Sp-service or hospital is entitled is calculated, based on the historical price levels (cf. supra) and on the number of stay days in 2000 and the quotum l Source: Koen Schoonjans Federal Governmental Service for Health Care
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 61 (expected number of stay days, based on a hypothetical occupancy rate of the beds) of 2002. m If the actual number of stay days in year t for instance is lower (higher) than the quotum in 2002, the budget for year t is reduced with the B1+B2-part of the budget for the (nonrealised) stay days below quotum (increased with 25% of the B1+B2 part of the budget for each stay day on top of the reference number). Moreover, the budget is paid to the institution, based on two parameters: • monthly ‘advance payments’ (this method is used for 80% of B1+B2) • a payment per stay day (this method is used for 20% of B1+ B2 and for all other parts of the budget). The price paid per stay day for year t is calculated on the basis of the actual number of stay days in t-2. Hence if the actual number of stay days in year t is larger (smaller) than the actual number of stay days in t-2, the institution will receive a (slightly) larger (smaller) budget than expected. Hence, it can be concluded that, at the microlevel, also the hospital budget for Sp-services is prospective (i.e. not based on the actual costs of the institution) and slightly variable (i.e. small annual variations, depending on the evolution of the number of stay days, relative to the number of stay days in the reference period). These beds are financed on a 7/7 days basis. Part-time hospitalisation (e.g. 5/7 days) is not provided within the system. This is contradictory as one of the main rehabilitation goals is reintegration in the home environment and patients should be encouraged to spend the weekends home as soon as possible. A funding system of “week day” hospitalisation is not applicable in Belgium – but inspiration may be found in the funding for partial hospitalisation in psychiatric hospitals (funding for day- or night hospitalisation in acute psychiatry (Ad, An), chronic psychiatry (Td, Tn) or child psychiatry (Kd, Kn), whereby the funding is based on an expected utilisation of the ‘partial hospital beds’ during weekdays (i.e. expected occupancy of 80% of the capacity during 251 days per year – or 56% per year). n Neither is there reimbursement for travel expenses to go home in the weekend (see further: transport convention). On the other hand there are no clearly defined criteria justifying hospitalisation. As demonstrated during the Pathos-Aggir-Socios project, coordinated by Prof. M-C Closon in 2003-2005 (“Spécificités des services Sp/Specifieke aspecten van de Sp diensten”), there is a large variability in characteristics of patients staying in organisations providing musculoskeletal or neurological rehabilitation services at the level of: • Independence • Rehabilitation needs • Age • Number of pathologies and the interaction The current Minimal Clinical Data (MKG/RMS) registration includes a registration of main pathology (principal diagnosis), degree of severity, main co-morbidities, principal interventions and some other data but does not provide enough information to map the variability at all mentioned levels. However, this variability influences the intensity of care and indirectly the financial needs. o Summarised, financing of services related to a hospital stay is characterised by: m In this section, the overall characteristics of the Sp-hospital funding system are described. No details are added and the specifics of an acute hospitals with an Sp-service (whereby patients may have part of their stay in an Spunit and part of their stay elsewhere in the hospital) are not incorporated either. n This funding system for partial hospitalisations is not automatically transferable to Sp-beds, since it covers daytime or nighttime hospitalisations (i.e. patients do not stay overnight or only overnight), whereas patients in Sp-beds do stay overnight (during weekdays). But it is a precedent of a hospital funding system, based on a 5/7 days per week hospitalisation. o Analyse de la spécificité des services Sp. Rapport Mars 2003. D. Thimus, M.C. Closon
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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