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64 Musculoskeletal & Neurological Rehabilitation KCE reports 57
personal assistance. Whereas the national fund organised quality control through
inspection visits of the centres, this is no longer organised by the regional funds.
Rehabilitation services are since 1991 financed by the RIZIV/INAMI. Rehabilitation is part
of the health care provisions system (art.34 of the law concerning compulsory health
insurance) which is mainly a fee for service system.
Most of the rehabilitation agreements have been established on a temporary basis in 1991
and since then been prolonged year by year. For musculoskeletal and neurological
rehabilitation, the subject of this study, there are different types of agreements: 46 “type
conventions 950” (28 in the region of Flanders, 13 in Wallonia and 5 in Brussels) and 7
“specific conventions 7.71” (2 in Flanders, 3 in Wallonia and 2 in Brussels). There are also
agreements with six reference centres for neuromuscular diseases (NMRC-convention)
7.89.2 (3 in Flanders, 1 in Wallonia and 2 in Brussels). Recently, reference centres for
cerebral palsy and spina bifida as well as for chronic fatigue and chronic pain were
introduced as well.
In the nomenclature (a fee schedule) of Physical Medicine & Rehabilitation (art. 22 and 23
“Physiotherapy”) three nomenclature codes for rehabilitation acts were established in
1991, and have been revised in August 2004. Since then the nomenclature includes more
specific criteria and a limitative list of pathologies. However, there is a great overlap
between these pathologies and those included in the agreements.
The nomenclature, as well as the 9.50 and 7.71 conventions, can be applied in both
hospitalised and ambulatory patients.
Rehabilitation for hospitalised patients is mostly organised in a day-price system of
specialized beds (Sp beds, musculoskeletal and neurological). Accreditation of hospital
beds is organized by the Ministry of Public Health. Again, both systems can be used
simultaneously (Sp bed/nomenclature or Sp bed/agreement). These beds exist since the
early nineties and the norms were published in 1993. The “day-price” also covers some
therapists and infrastructure for rehabilitation. Their historical background can be very
different. Many of them, mainly the beds in isolated services (also called “categoral”
hospitals), originated from the formal R- or V-beds (hospital law 1985). Others are
reconverted acute beds (C- or D-beds) in general hospitals. The financing is depending on
the formal day-price of the original bed-type (acute or chronic, general or “categoral”
hospital) and varies substantially. The day-prices are mainly set historically and there are
no objective criteria to differentiate between them. The last decade we saw a spectacular
growth of the number of Sp-beds. For instance, the number of S2 beds (Sp beds for
“musculoskeletal” disorders) increased between 2003 and 2005 from 1.775 to 1.996.
5.1.3.1 Conventions
Within the convention system, the following conventions are relevant for musculoskeletal
and neurological rehabilitation.
• “Convention 7.71: Specific and type conventions – Institutions for
motor rehabilitation”: these conventions exist under two distinct
forms (described as such in the “Riziv Audit Revalidatiesector June
2004”):
o “Specific reference centres for important orthopaedic and/or
neurological rehabilitation”. These reference centres provide
rehabilitation to patients with highly complex disorders and
provide treatments of at least half a day.
o “Specific categoral centres”: category specific rehabilitation
centres specialised in one pathology such as multiple sclerosis
or traumatic brain injury.
• “Convention 9.50: Type convention – Institutions for ‘locomotor’
rehabilitation”: 48 (since 2005 only 46) general rehabilitation centres
located across the different regions. The 9.50 centres provide
rehabilitation to patients with complex disorders or more important
impairments and disabilities and lasting problems. This convention