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

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