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6 APPENDICES Physiotherapy KCE reports vol. 40 Various therapeutic possibilities of ICF 5 : propagating the understanding of ICF and its possible use in physiotherapy care. Effective communication in physiotherapy: recommendations on ways of communicating with stakeholders (cf. supra). The program is executed according to a time schedule. By October 2006 all modular components should have been tested and evaluated. 1.4.3. Current Points of Contention The recent reforms in the field of reimbursed physiotherapy were designed to avoid unnecessary expenses in care whilst enhancing quality of care. Measures were taken regarding both the level of patient access and access to the profession (2). Criticisms mainly address the arbitrary nature of E- and F-listing certain disorders as opposed to others. Also, the number of sessions per common disorder qualifying for maximum reimbursement is considered too low. Moreover, the new reimbursement scheme is seen to disregard the potential preventive nature of physiotherapy care, thus hampering overall savings in health care (4, 5). The current practice of limiting entry to the profession posterior to graduation is criticized by some who feel the content of the 2005 examination was ill-considered. More in general, it is claimed entrance examinations should limit access to education, thus avoiding aspiring future physiotherapists spending unnecessary years of training. 1.5. HEALTH INFORMATION SYSTEMS Traditionally, sickness funds collect data on reimbursed interventions by coded numbers. These data can then be split out according to chronology, type of physiotherapist, point of care. Their use is mainly limited to administrative purposes (follow-up of billing regulations). As emphasized by the WVVK in their quality project a rationalized patient record system can help to enhance and standardize quality of care. The WVVK, however, does not champion the use of these data for benchmarking exercises, scientific research and/or external auditing. 5 International Classification of Functioning, Disability and Health, as defined by the World Health Organisation ICF is useful to understand and measure health outcomes. It can be used in clinical settings, health services or surveys at the individual or population level. Thus ICF complements ICD- 10
KCE reports vol. 40 APPENDICES Physiotherapy 7 1.6. KEY POINTS The Belgian health care system is based on a statutory insurance scheme, traditionally distinguishing between salaried workers and the self-employed. Regulation and supervision of the health care system is centralized at the federal level. Educational requirements are set at minimally 4 years of post-secondary education. The number of recognised physiotherapists was estimated at 28.252 in 2004. Depending on the category of physiotherapy care (type of disorder), the number of (additional) sessions and the patient s statutory profile the level of maximal reimbursement varies between 65% to 90% of official RIVZ/INAMI tariffs for physiotherapists practicing within reimbursement agreements. Currently, continuing development initiatives are developed and centralized by the professional associations. An approach toward physiotherapy that accentuates the scientific underpinning of physiotherapy care is favoured by the scientific member-led association WVVK . Recent reforms in the field of reimbursed physiotherapy were designed to rationalize both patient access and access to the profession. Criticisms of these reforms mainly address the arbitrary nature of reimbursement. The use of health information data is mainly limited to administrative purposes (follow-up of billing regulations).
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