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KCE Reports 80S Maximum Billing Supplement 161
10.2 UPDATE 2004-2008
Since 2004 the number of implants and medical devices with a safety margin has
increased substantially. To obtain a more accurate assessment of the budgetary cost of
the integration of the safety margin in 2008, an update of the results in section 6.3.1 in
the main report is necessary. Column 4 in Table AX.2 gives a list of nomenclature codes
referring to implants and medical devices with a safety margin in March 2008. For the
majority of these codes, a one-to-one relationship between the codes of 2004 and 2008
could be made on the basis of the wording of the nomenclature code. This made it
possible to assign the safety margin applicable in 2008 to them. For other nomenclature
codes it seemed impossible to link codes of 2004 and 2008 in a reliable way.
The update from 2004 to 2008 was worked out in three steps. First, for implants and
medical devices with a safety margin in 2004, the budgetary cost in 2004 was raised by
the increase in the number of cases for these nomenclature codes between 2004 and
2008 qq (+3.58% or €8 441 788). Second, for codes in 2008 which could be linked to
codes in 2004, the budgetary cost of integrating the safety margin into the MABcounters
was simulated by assigning the safety margin of the codes in 2008 to each code
belonging to a certain group in 2004. A group was defined as all nomenclature codes
within the same wording (e.g. hydrocephalic valves). In case the codes of a group have
different safety margins in 2008, a weighted safety margin was calculated in which the
weight was based on the share of each code in the total number of cases. Taking also
account of the increase in the number of cases between 2004 and 2008, the budgetary
cost amounts to about €219 000. Third, for codes without a link between 2004 and
2008, the budgetary cost was approximated by multiplying the theoretical rr safety
margin of each nomenclature code by the number of cases. The result is the supplement
paid by the patient and equals the increase in the MAB-counters. Next, in line with the
simulation results for implants and medical devices with a safety margin in 2004, 80% of
the increase in the MAB-counters was considered as the budgetary cost for
RIZIV/INAMI (€53 763). Adding up the results of the previous steps, gives a total cost
of about €8 715 000 for the integration of the safety margin of implants and medical
devices into the MAB-counters in 2008. ss
qq Available from RIZIV/INAMI.
rr Theoretical since hospitals are free to charge the safety margin.
ss Steps 2 and 3 are exclusive of the self-employed and the cost is expressed in prices of 2004.