Optimisation of RIZIV – INAMI lump sums for incontinence

LIST OF FIGURES 8 -- LIST OF TABLES 10 -- LIST OF ABBREVIATIONS 13 -- SCIENTIFIC REPORT 16 -- 1 GENERAL INTRODUCTION 16 -- 1.1 AIM OF THE STUDY 16 -- 1.2 SCOPE 17 -- 1.3 REPORT OUTLINE17 -- 2 INCONTINENCE: PATIENTS, DIAGNOSIS AND TREATMENTS 18 -- 2.1 INTRODUCTION 18 -- 2.1.1 Chapter outline 18 -- 2.1.2 Methods 18 -- 2.1.3 PICO 18 -- 2.1.4 Medline search 19 -- 2.1.5 Cochrane search 19 -- 2.1.6 Embase search .20 -- 2.1.7 Grey literature search and websites incontinence societies 20 -- 2.1.8 Results from search: retrieved reviews and guidelines 20 -- 2.2 DEFINITION INCONTINENCE.21 -- 2.2.1 Urinary incontinence in children and adolescents 21 -- 2.2.2 Urinary incontinence in women and men.22 -- 2.2.3 Faecal incontinence 22 -- 2.3 CAUSES OF INCONTINENCE 23 -- 2.3.1 Neurological causes23 -- 2.3.2 Non-Neurological causes.23 -- 2.4 MANAGEMENT OF URINARY INCONTINENCE IN HEALTHY ADULTS 25 -- 2.4.1 Conservative treatment.29 -- 2.4.2 Pharmacological treatment .32 -- 2.4.3 Surgical management 34 -- 2.4.4 Cure rates 38 -- 2.4.5 Initial evaluation and management .40 -- 2.4.6 Care pathway for the management of urine incontinence in men 41 -- 2.4.7 Care pathway for the management of urine incontinence in women 45 -- 2.5 MANAGEMENT OF URINARY INCONTINENCE IN THE FRAIL ELDERLY AND THE COGNITIVELY IMPAIRED 49 -- 2.5.1 Conservative options 49 -- 2.5.2 Pharmacological treatment .50 -- 2.5.3 Surgical treatment in the frail older person .52 -- 2.6 MANAGEMENT OF URINARY INCONTINENCE IN CHILDREN 56 -- 2.6.1 Initial assessment.56 -- 2.6.2 Initial management 57 -- 2.6.3 Specialised management.59 -- 2.7 MANAGEMENT OF FAECAL INCONTINENCE.62 -- 2.7.1 Initial clinical assessment.62 -- 2.7.2 Specialised management (primary or secondary care) 66 -- 2.7.3 Surgery for faecal incontinence 66 -- 2.7.4 Care pathway for the management of faecal incontinence in frail older women and men.69 -- 2.8 MANAGEMENT OF NEUROLOGICAL INCONTINENCE 72 -- 2.8.1 Management of neurogenic urinary incontinence72 -- 2.8.2 Management of faecal incontinence in neurological patients 76 -- 3 REIMBURSEMENT FOR INCONTINENCE IN BELGIUM 81 -- 3.1 OVERVIEW OF RIZIV – INAMI REIMBURSEMENT/PAYMENTS FOR PATIENTS WITH INCONTINENCE .81 -- 3.1.1 Reimbursement of physiotherapy sessions for pelvic re-education 81 -- 3.1.2 Reimbursement of continence nurse consultation 82 -- 3.1.3 Reimbursement of medication for incontinence 82 -- 3.1.4 Reimbursement of technical medical interventions, implants and other invasive medical devices 85 -- 3.1.5 Reimbursement/payments for incontinence materials 85 -- 3.2 REIMBURSEMENT/PAYMENTS BY FEDERATED INSTANCES – FOR PERSONS WITH A HANDICAP.96 -- 3.2.1 VAPH – Flemish community 96 -- 3.2.2 AWIPH – AVIQ-Handicap – French Community 99 -- 3.2.3 PHARE (Personne Handicapée Autonomie Recherchée) 101 -- 3.2.4 German Community 101 -- 3.3 FINANCIAL INTERVENTIONS BY COMPLEMENTARY INSURANCE OF SICKNESS FUNDS 101 -- 3.4 OTHER COMPENSATIONS 101 -- 4 INCONTINENCE IN BELGIUM: DATA OVERVIEW.102 -- 4.1 INTRODUCTION 102 -- 4.2 METHODS 102 -- 4.2.1 MZG-RHM 2014: hospitalisations for incontinence 102 -- 4.2.2 EPS 2008-2015: sample of health insurance reimbursements and population data 104 -- 4.2.3 RIZIV – INAMI data: numbers and amounts reimbursed for incontinence (lump sums, therapeutic interventions, implants or drugs) 106 -- 4.3 DATA ON DIAGNOSIS AND TREATMENT 106 -- 4.3.1 MZG-RHM 2014: hospitalisations for incontinence 106 -- 4.3.2 EPS 2008-2015: sample of health insurance reimbursements and population data 112 -- 4.3.3 RIZIV – INAMI data: numbers and amounts reimbursed for incontinence (lump sums, therapeutic interventions, implants or drugs) 120 -- 4.4 ESTIMATING THE NUMBER OF PEOPLE WITH UNTREATED INCONTINENCE 130 -- 5 INTERNATIONAL PERSPECTIVE 131 -- 5.1 INTRODUCTION 131 -- 5.2 METHODS 131 -- 5.3 SELECTION OF COUNTRIES 131 -- 5.4 CROSS-COUNTRY ANALYSIS 132 -- 5.4.1 Absorbent materials: included or excluded from the health benefit basket 132 -- 5.4.2 Absorbent materials: eligible indications and age groups 134 -- 5.4.3 Reimbursement method 140 -- 5.4.4 Strengths and weaknesses of different reimbursement methods 144 -- 5.4.5 Patient classification and reimbursement amounts 145 -- 5.4.6 Involved professionals for assessing incontinence 151 -- 6 COST OF ABSORBENT MATERIALS 154 -- 6.1 INTRODUCTION 154 -- 6.2 UROBEL COST ESTIMATES 154 -- 6.3 VAPH DATA 155 -- 6.4 DATA ESTIMATES FROM DUTCH COLLEGE VOOR ZORGVERZEKERINGEN 159 -- 7 BELRAI 159 -- 7.1 INTRODUCTION 159 -- 7.2 BELRAI ITEMS ON (IN)CONTINENCE 160 -- 7.3 CLINICAL ASSESSMENT PROTOCOLS (CAPS) 161 -- 7.3.1 CAP for urinary incontinence 161 -- 7.3.2 CAP for bowel conditions 163 -- 7.4 ASSESSMENT OF THE POSSIBLE USE OF BELRAI FOR THE INCONTINENCE LUMP SUMS 164 -- 7.4.1 Sensitivity of the BelRAI scale for incontinence 164 -- 7.4.2 For which patients can the BelRAI be filled out? 165 -- 7.4.3 Who fills out the BelRAI? 165 -- 8 POLICY ANALYSIS: ASSESSMENT OF THE CURRENT SITUATION AND PROPOSALS FOR IMPROVEMENT 166 -- 8.1 INTRODUCTION 166 -- 8.2 METHODS 166 -- 8.3 REIMBURSEMENT METHOD: LUMP SUM VERSUS REIMBURSEMENT PER ITEM 167 -- 8.3.1 Assessment of the current situation 167 -- 8.4 ACCESS TO THE INCONTINENCE LUMP SUMS 167 -- 8.4.1 Evaluation of the current situation 167 -- 8.4.2 Proposals for improvement 168 -- 8.5 ELIGIBLE INDICATIONS 168 -- 8.5.1 Assessment of the current situation 168 -- 8.5.2 Proposals for improvement 171 -- 8.6 PATIENT CATEGORISATION 172 -- 8.6.1 Assessment of the current situation 172 -- 8.6.2 Possible typologies of patients 175 -- 8.6.3 Proposals for improvement 177 -- 8.7 THE VALIDITY PERIOD OF THE LUMP SUMS 178 -- 8.7.1 Assessment of the current situation 178 -- 8.7.2 Proposals for improvement 178 -- 8.8 ACCESS TO DIAGNOSIS, TREATMENT AND TOILETING AIDS 178 -- 8.8.1 Assessment of the current situation 178 -- 8.8.2 Proposals for improvement 180 -- 8.9 OPTIMISING THE PATHWAYS TO THE LUMP SUMS 182 -- 8.9.1 Assessment of the current situation 182 -- 8.9.2 Proposals for improvement 182 -- 8.10 FINANCIAL ACCESSIBILITY OF TREATMENTS AND SUPPORT AIDS 183 -- 8.10.1 Assessment of the current situation 183 -- 8.10.2 Proposals for improvement 184 -- 8.11 PATIENT INFORMATION ON SUPPORT AIDS 184 -- 8.11.1 Assessment of the current situation 184 -- 8.11.2 Proposals for improvement 184 -- 8.12 PATIENT AWARENESS AND HEALTH LITERACY 185 -- 8.12.1 Appraisal of the current situation 185 -- 8.12.2 Proposals for improvement 185 -- 8.13 FOCUS ON THE SETTING: NURSES 185 -- 8.13.1 Appraisal of the current situation 185 -- 8.13.2 Proposals for improvement 185 -- 8.14 FOCUS ON THE SETTING: PHYSIOTHERAPISTS 186 -- 8.14.1 Appraisal of the current situation 186 -- 8.14.2 Proposals for improvement 186 -- 8.15 FOCUS ON THE SETTING: CONTINENCE CLINICS 187 -- 8.15.1 Appraisal of the current situation 187 -- 8.15.2 Proposals for improvement 188 -- 8.16 INTERVENTION BY THE FEDERAL AND FEDERATED LEVELS 188 -- 8.16.1 Appraisal of the current situation 188 -- 8.16.2 Proposals for improvement 188 --  APPENDIX TO CHAPTER 2 189 -- APPENDIX 1. SELECTION OF REFERENCES 189 -- APPENDIX 1.1. MEDLINE AND COCHRANE.189 -- APPENDIX 1.2. EMBASE 191 -- APPENDIX 2. SELECTION GUIDELINE – AGREE ICS 2017 194 -- APPENDIX 3. INCONTINENCE IMPACT QUESTIONNAIRES: IIQ7 AND IIQ LONG VERSION 196 --  APPENDIX TO CHAPTER 3 199 -- APPENDIX 1. HOME NURSE FORM WITH KATZ SCALE 199 -- APPENDIX 2. REQUEST FORM FOR “SMALL LUMP SUM” FOR INCONTINENCE 200 --  APPENDIX TO CHAPTER 4 201 -- APPENDIX 1. NUMBER AND TYPE OF ADMISSIONS, AGE AND SEX PER APR-DRG (2014) 201 -- APPENDIX 2. TEN MOST FREQUENT PROCEDURE PERFORMED PER MDC (2014)202 -- APPENDIX 3. SELECTION CRITERIA TO EXTRACT EPS DATA 2008-2015 .204 -- APPENDIX 4. VARIABLES DERIVED FROM EPS VARIABLES (2015) 214 -- APPENDIX 5. VOLUME (DDD), REIMBURSEMENTS (€) AND NUMBER OF PATIENTS FOR URINARY FREQUENCY AND INCONTINENCE DRUGS (RIZIV – INAMI 2008-2017) 223 -- APPENDIX 6. – NUMBER OF IMPLANTS AND REIMBURSEMENTS FOR INCONTINENCE (DOC N 2016) 225 -- REFERENCES 228