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KCE reports 57 Musculoskeletal & Neurological Rehabilitation 63
• The relation between physiatrist and therapists
• The relation between physiatrist and patients
• The guarantees for optimal supply of care to the patients.
Financing of rehabilitation activities is characterised by two different payment systems
which differ little concerning the type of financed rehabilitation activity (both
multidisciplinary for nearly the same diagnoses), or the unit of payment. The price as well
as the paid provider differ.
Due to a differentiation of rehabilitation organisations in function of the access to different
payment systems, the income of rehabilitation organisations, the distribution of
responsibilities and positions of authorities within these organisations differ without a
formal link to delivered rehabilitation services.
The current double payment system appears irrational. The concern is that different
payment systems are applied while patients in one setting of care may, in some instances,
be similar to patients in other settings of care.
5.1.3 Payment systems for musculoskeletal and neurological rehabilitation
activities
As mentioned above, two main systems exist for (multidisciplinary) musculoskeletal and
neurological rehabilitation:
• Hospital day price of Sp-beds: S2 musculoskeletal and S3 neurological
(inpatients only)
• Rehabilitation activities (in- as well as outpatients):
o Rehabilitation agreements (“conventions”) between the
RIZIV/INAMI and the health care provider .
o Nomenclature of Physical Medicine & Rehabilitation (a fee
schedule: “K”)
There is a substantial overlap between the different systems and it is not always clear
which system should be used. The two systems (nomenclature and conventions) for
rehabilitation activities could even be used sequentially for a certain number of pathologies
until very recently (rules changed August 1 st 2006, as will be explained in chapter 5.1.5).
Nomenclature acts are physician’s fees whereas conventions are agreements between
RIZIV/INAMI (Insurance committee) and the health care providers (institutions). Hospital
day prices are also paid to the hospitals (except for the “fee for supervision” which is
again a fee for the physician).
In order to understand the existence of the different payment systems in Belgium, a short
historical review seems necessary. In 1963 the National Institute of Sickness and Invalidity
Insurance (RIZIV/INAMI) was founded by the Ministry of Social Affairs, as well as the
“Rijksfonds voor Sociale Reclassering van de Mindervaliden” or “Fonds Maron” (further
called “National Fund”) by the Ministry of Employment and Work. Most aspects of
rehabilitation resorted under the “National Fund” and the main objective was to promote
employment of persons with a disability. Therefore the maximum age for subscription was
set at 65 years.
Due to the changing governmental structure of Belgium, the “National Fund” was
abolished in 1991 and replaced by four different Regional Funds (VFSIPH, AWIPH,
COCOF, Dienststelle der Deutschsprachigen Gemeinschaft für Personen mit einer
Behinderung sowie für die besondere soziale Fürsorge. Note that since April 2006 the
VFSIPH (Vlaams Fonds voor Sociale Integratie van Personen met een Handicap) is called
VAPH (Vlaams Agentschap voor Personen met een Handicap)). These funds are
responsible for accreditation and subsidies of the Rehabilitation centres. In 1995 though,
the subsidies for the intramural (in a hospital) rehabilitation centres were abolished by the
Flemish Fund (VFSIPH). On the other hand these funds finance measures promoting social
and/or professional integration of disabled persons, as well as individual material or