The Zorginstituut Nederland advises Minister Van Ark for Medical Care to reimburse restorative care to seriously ill covid-19 patients in a broader manner from the basic insurance. The extended reimbursement will apply to both patients who have been in the ICU and patients who have been treated in nursing wards or who have been seriously ill at home.
It is certain that the minister will quickly adopt the advice. Her predecessor Van Rijn asked the Zorginstituut to make a proposal for a broader reimbursement for restorative care, because many patients suffer from long-term residual complaints.
Now this type of care is only insured to a limited extent by the basic insurance, and moreover only in very specific cases. Additional insurance is possible through additional insurance, but not everyone is (sufficiently) additionally insured. The intention is that the broader reimbursement from the basic insurance will take effect in the very short term.
Conditions and maximum
The reimbursement of restorative care under the basic insurance applies for six months after the assessment and for a maximum of 50 hours of physiotherapy or remedial therapy, eight hours of occupational therapy or seven hours of dietetics. The care must be prescribed by a medical specialist or general practitioner.
A reassessment by the general practitioner will follow three months after the assessment. If lung damage or damage to the musculoskeletal system still exists after six months, a medical specialist may prescribe another six months of restorative care.
Speech therapy or mental health care may also be necessary, but the Care Institute’s advice is not about broader reimbursement.
Long-term complaints
The advice now has become clear that many seriously ill covid-19 patients have long-term health complaints. This concerns, for example, shortness of breath and loss of fitness, but also cognitive complaints. Not only patients who have been in IC are affected. Patients who are nursed in covid wards or who have not been hospitalized at all often suffer from this.
The Zorginstituut assumes that a large number of seriously ill corona patients require much more restorative care than they are currently insured for. People who have been in ICU would normally only be reimbursed for physical therapy after the 21st treatment. So now the treatments will be reimbursed from the start.
The Healthcare Institute assumes that a total of approximately 16,000 patients will make use of the larger reimbursement. In the first year after the start of the corona outbreak in the Netherlands, the costs will amount to approximately 28 million euros, but they may increase depending on the further course of the pandemic.
Exceptional
Given the enormous impact that covid-19 has on these patients and the scale of the social problem that has arisen as a result, the Healthcare Institute deviates from its own rules. Normally, only care that has been scientifically proven to be effective is reimbursed. This evidence is not yet available for recovery care after Covid-19, the disease is too new for that.
However, says the Zorginstituut, an exceptional time requires exceptional advice and that is why it is advisable to extend the reimbursement of restorative care under the basic insurance. “The overriding consideration here is solidarity: the coronavirus outbreak has developed into an exceptional pandemic affecting many patients.”
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