Het gebruik van kinesitherapie en van fysische geneeskunde ... - KCE

KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 7
The framework of analysis is similar to that utilised in the project related to
physiotherapy: care organisation, human resources and task allocation, financing and
conditions of reimbursement, quality, regulation and control.
The second part describes the general rehabilitation consumption. This descriptive
analysis was carried out based on a representative population sampling (statutory health
insurance) drawn up by the Common Sickness Funds Agency (IMA-AIM). The sampling
amounted to 1/40 of the population covered by compulsory health insurance. The 2003,
2004 and 2005 data were utilised in order to compare two consumption periods i.e.
before versus after the reform of Physical and Rehabilitation Medicine (August 2004).
This descriptive analysis, based on individual data from the IMA sampling, was compared
with the exhaustive but aggregated data available to the National Institute for Health
and Disability Insurance (RIZIV-INAMI) in order to define the limitations of the IMA
sampling. This study analyses the rehabilitation consumption (outpatient and hospital
treatment) and the care invoiced within the framework of rehabilitation conventions.
Two main lines are considered i.e. rehabilitation consumption by the patient and care
episode.
A third part consists of the rehabilitation consumption specific for surgical operations.
This last part deals with the main research question, looking for the potential
explanatory factors behind the observed differences in rehabilitation care consumption.
The statistical, descriptive and explanatory analyses of rehabilitation consumption were
conducted for a limited number of targeted surgical operations. These involved the
operations most frequently followed by physiotherapy or Physical and Rehabilitation
Medicine. Most of these operations were performed during hospitalisation. They did not
systematically require a multi-disciplinary approach. Rehabilitation conventions (between
health institutions and the RIZIV-INAMI) were seldom an option.
Finally, the last chapter provides a conclusion and discussion about the
consumption of physiotherapy and Physical and Rehabilitation Medicine in Belgium.
Based on these results, recommendations are made in the executive summary.
1.2 DESCRIPTION OF KIND OF REHABILITATION
Three types of rehabilitation care are covered by the Belgian compulsory health
insurance:
• care by physiotherapists (M-nomenclature),
• care by physicians specialised in Physical and Rehabilitation Medicine (Knomenclature),
• rehabilitation conventions between health care institutions and the National
Institute for Health and Disability Insurance (RIZIV-INAMI).
1.2.1 Nomenclature system
The services covered by the statutory health insurance (SHI) are described in the
nationally established fee schedule (the “nomenclature”), including more than 8 000
services. For each service, the invoice code, key letter, relative value, tariff, and
reimbursement rate are specified. The tariff is calculated by multiplying the key letter
(which is assigned a certain monetary value) by the relative value. Rehabilitation
activities reimbursed by the SHI are listed in article 22 and 23 of the nomenclature. The
corresponding invoice codes for PRM services are labelled with the key letter “K”
which is the reason why they are called the K-nomenclature. 4-6 Physiotherapy
7, 8
services, on the other hand, are invoiced with codes from the M-nomenclature.
The utilisation of these nomenclatures is governed by different rules.
• Disorders
There is no list of covered complaints within the framework of
compulsory insurance. Nevertheless, certain diseases can benefit from a
higher number of better reimbursed sessions after prior notification to
the medical advisor from the sickness fund. There disorders are listed as
follows: