Rehabilitation: too many referrals, benefits inadequate to meet needs. This is about to change

According to the analysis of the decision problem carried out by the Agency for Health Technology Assessment and Tarification, prepared at the request of the Minister of Health, for the purpose of developing the Concept for changes in the organization and operation of inpatient rehabilitation in the health care system, it follows that the area of inpatient rehabilitation is affected by the following problems:

1) Redundancy of referrals issued, which do not always correlate with actual rehabilitation needs;

2) The lack of criteria differentiating the health (rehabilitation) needs of patients and the lack of specific criteria for including patients in rehabilitation result in the provision of services inadequate to the needs;

3) The lack of specific objective tools defining a patient's clinical and functional status which translates into providers preferring patients with lower levels of dysfunction;

4) A large number of people waiting for services, especially patients who do not receive rehabilitation treatment at the optimal time appropriate to their current needs, so that their functional condition may deteriorate while waiting for services;

5) long waiting times for patients to receive rehabilitation services in particular, with regard to patients waiting for services after injuries and after treatment of acute medical incidents;

The lack of a requirement to define a rehabilitation plan, including defining a therapeutic goal as a criterion for evaluating the effectiveness of treatment.

In order to solve the problems presented, it is proposed to amend the provisions of the regulation, which include:

1) Adding new definitions;

2) specifying the medical personnel authorized to provide services;

3) Clarification of eligibility criteria for benefits;

4) Expanding the list of medical scales and classifications for assessing the clinical condition or functioning of recipients;

5) Introduction of efficiency mechanisms in the organization of the rehabilitation system mainly for the benefit of patients after acute disease incidents or injuries;

6) clarification and standardization of the conditions for the provision of guaranteed benefits;

7) clarifying the areas of securing benefits provided under specific conditions;

8) Removal of the required separate elements for referrals to home physiotherapy and outpatient physiotherapy services;

9) updating the list of entities authorized to issue referrals in each range of benefits;

10) Unification of nomenclature across all benefits to eliminate interpretation problems;

11) to adapt the regulations to changes made in other regulations.

The most significant change is the expansion of the list of medical scales and classifications for assessing a recipient's clinical or functional condition. From the therapeutic point of view, the proposed scales and classifications are a helpful tool for making therapeutic decisions and determining the need for care, which allows the selection of the appropriate form and level of rehabilitation, as well as for evaluating the effectiveness of planned and carried out activities, or for possible adjustment of the therapeutic management plan. From a systemic point of view, the obligation to assess the condition of the recipient will allow the determination of profiles of patients benefiting from rehabilitation and, in addition, will allow an objective comparison of individual providers in terms of the quality of services provided and the referentiality of centers.

All of the proposed changes described above should help improve access to rehabilitation services, especially for patients who, due to their condition (clinical and functional), should receive rehabilitation services in the shortest possible time, guaranteeing the effectiveness of previously performed surgical procedures or rehabilitation procedures only.

Source: RCL