Rehabilitation Services Provision and Payment

Abstract

Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care. The three most important types of services are acute, postacute, and long-term rehabilitation services. Health-related rehabilitation services for patients with SCI must be able to provide high-quality equipment and a well-trained, highly specialized and multiprofessional team of rehabilitation workers. The principles of payment for SCI rehabilitation services vary according to the organization of health care systems, which primarily depends on the sources of money (eg, from national health care systems, other health insurances, or out of pocket). Funding systems and payment criteria may influence service provision and justice in service delivery. It is important to analyze the provision of rehabilitation services and the related funding system using uniform assessment and evaluation tools.

International Classification of Service Organization in Rehabilitation: An updated set of categories (ICSO-R 2.0)

“…We have put forward a first proposal of the ICSO-R (14) to facilitate the discussion. Various papers report experiences with the application of ICSO-R (16,17), which were all considered in developing ICSO-R 2.0. This methodological approach to the development of ICSO-R 2.0 has some limitations.…”

“…to provide a meaningful, cross-culturally applicable, but also simple and unequivocal, way of operationalization of every aspect depicted in ICSO-R. The work of Roe et al (17) provides valuable information for this project. Here, the different professions, competencies, traditions and available instruments and concepts must be taken into account.…”

“…• Service provider (including the framework of the institution, the resources and some aspects of service organization) responding to questions concerning where, by whom, and in which context the service is delivered; • Service funding (including the main sources of income and payment of delivered services) aiming at responding to the question what are the principles of financial resources; • Service delivery (including the main strategy applied to the users, aspects of intensity and duration of intervention and the way the service is organized), focusing on the questions what, for what, and how the services are delivered to the user. The first proposal for dimensions of the ICSO-R (11) was tested at European and national levels (10,(15)(16)(17). In addition, a couple of unpublished applications of the first version of the ICSO-R were conducted in different settings and countries.…”

Rehabilitation Services, Self-Advocacy and Psychosocial Adaptation as Determinants of Employment among Persons with Spinal Cord Injury

“…Unfortunately, very little is known in the research literature on comprehensive rehabilitations needs of individuals with SCI or the impacts of rehabilitation services on community participation such as employment of persons with SCI. According to Gutenbrunner, Blumenthal, Geng, and Egen [32] individuals with SCI need long term rehabilitation services that is interdisciplinary in nature. Such rehabilitation services include services that address community re-entry issues such as assistive technology, mental health issues, vocational rehabilitation, education, adaptation to living environment, and others.…”

Cost Analysis of Inpatient Rehabilitation after Spinal Injury: A Retrospective Cohort Analysis

“…Spine fractures account for 3-6% of all skeletal fractures while acute spinal cord injury (SCI) has an estimated prevalence of 54 cases per 1 million people in the United States and an overall in-hospital mortality rate approaching 8% [1]. After initial stabilization and treatment, SCI patients typically require and benefit from intensive acute rehabilitation [2]. In the Veterans Healthcare Administration, each patient with SCI faces a lifetime healthcare cost of $1.1 to $5.4 million depending on the level of injury and patient age [3].…”