Model for the organization and reimbursement of psychological and orthopedagogical care in Belgium

107 p.ill.,1 INTRODUCTION 10 -- 2 OBJECTIVES AND METHODS 11 -- 3 THE LEGISLATIVE BELGIAN CONTEXT 13 -- 3.1 LAW OF 4 APRIL 2014 GOVERNING MENTAL HEALTH PROFESSIONS AND AMENDING ROYAL DECREE NO. 78 OF 10 NOVEMBER 1967 ON THE PRACTICE OF HEALTH PROFESSIONS 13 -- Legal framework on mental health.13 -- Reason for the Law of 4 April 2014 13 -- The development of the law 15 -- Analysis of the key provisions of the Law of 4 April 2014 15 -- Mental Health Council19 -- 3.2 RECENT EVOLUTIONS (JANUARY 2016).19 -- 4 CURRENT SITUATION OF MENTAL HEALTHCARE IN BELGIUM.20 -- 4.1 SOME CONCERNS ABOUT MENTAL HEALTH CARE IN BELGIUM21 -- 4.2 THE POSITION OF CLINICAL PSYCHOLOGISTS, CLINICAL ORTHOPEDAGOGISTS AND PSYCHOTHERAPISTS IN THE BELGIAN MENTAL HEALTH CARE SYSTEM21 -- ‘Centra voor geestelijke gezondheid’ (CGG) – ‘Services de santé mentale’ (SSM) 21 -- Various new initiatives 23 -- The 6th State Reform 26 -- 4.3 MENTAL HEALTHCARE PRACTITIONERS: REGULATION, EDUCATION AND WORK SETTING.26 -- Physicians 26 -- Clinical psychologists.27 -- Psychotherapists28 -- Clinical orthopedagogists 29 -- 4.4 CURRENT FINANCING OF AMBULATORY PSYCHOLOGICAL AND PSYCHOTHERAPY INTERVENTIONS 30 -- Financing of psychological and psychotherapeutic interventions delivered by physicians in ambulatory setting 30 -- 4.4.2 Financing for psychological and psychotherapeutic interventions delivered by psychologists or psychotherapists in ambulatory settings31 -- 4.4.3 Financing for psychological and psychotherapeutic interventions delivered in centres for mental health care (CGG – SSM) 32 -- 4.5 COST OF PSYCHOLOGISTS AND PSYCHOTHERAPISTS IN BELGIUM32 -- Current tariffs for a psychotherapist consultation 32 -- Cost of a psychologist in hospital setting 33 -- Cost of a psychologist in centres for mental healthcare 33 -- 5 INTERNATIONAL COMPARISON 34 -- 5.1 INTRODUCTION 34 -- Objective 34 -- Methods .34 -- Structure of the chapter .34 -- 5.2 THE MENTAL HEALTH CARE PRACTITIONERS 35 -- Regulated professions and functions in the mental health care system 35 -- Work settings .37 -- Education of the mental health practitioners 40 -- Roles of the mental healthcare practitioners .44 -- 5.3 PATIENT’S ACCESS TO REIMBURSED CLINICAL PSYCHOLOGY, PSYCHOTHERAPY AND CLINICAL ORTHOPEDAGOGY INTERVENTIONS44 -- Conditions for reimbursement44 Direct access versus referral systems 47 -- Reimbursed indications for psychological and psychotherapy interventions in ambulatory settings 50 -- Reimbursed psychotherapeutic treatments 52 -- Intensity of the reimbursed treatments 55 -- 5.4 PAYMENT FOR MENTAL HEALTH CARE SERVICES 57 -- Payment of mental health services in GP setting 60 -- Payment of mental health care workers in other ambulatory settings 60 -- Payment of mental health workers in secondary and tertiary settings 62 -- 5.5 QUALITY MANAGEMENT 62 -- 6 BELGIAN STAKEHOLDERS’ VIEWS ON THE ORGANIZATION AND THE REIMBURSEMENT 63 -- 6.1 INTRODUCTION 63 -- 6.2 METHODOLOGY.63 -- General design 63 -- Participants 63 -- Data collection 64 -- Analysis 65 -- 6.3 FINDINGS 65 -- Preliminary considerations.65 -- How to organize clinical psychology, clinical orthopedagogics and psychotherapy?66 -- How to finance clinical psychology, clinical orthopedagogics and psychotherapy in the context of the national health insurance? 69 -- How to support quality 72 -- Additional issues: 72 -- 6.4 CONCLUSION .72 -- 7 INTERMEDIARY RESULTS: TENTATIVE MODEL BASED ON, FOREIGN EXAMPLES AND STAKEHOLDER INTERVIEWS AND “EERSTE LIJNS PSYCHOLOGISCHE FUNCTIE PROJECTEN” 74 -- 7.1 A SYSTEM WITH TWO COMPONENTS.74 -- First line care accessible to all 74 -- A second line of more specialized care for the people who need it, regulated through a gatekeeping 77 -- 7.2 REIMBURSEMENT OF THE PSYCHOLOGY/ORTHOPEDAGOGY CARE 79 -- 8 TEST OF THE TENTATIVE MODEL TO ORGANIZE ACCES TO PSYCHOLOGICAL (AND ORTHOPEDAGOGIC) CARE IN BELGIUM AMONG STAKEHOLDERS 80 -- 8.1 METHODOLOGY.80 -- Design80 -- Participants 80 -- Data collection tools 80 -- 8.2 RESULTS OF THE SURVEY 80 -- Participants 80 -- Proposals according to their acceptability level.81 -- 8.3 ADAPTIONS TO THE MODEL 84 -- 8.4 RESULTS OF THE MEETING .85 -- 8.5 CONCLUSION OF THE STAKEHOLDERS CONSULTATION 86 -- 9 FINANCING OF THE PROPOSED MODEL87 -- 9.1 POSSIBLE MODELS FOR FINANCING MENTAL HEALTH CARE87 -- 9.2 A FINANCIAL MODEL FOR PSYCHOLOGICAL CARE IN BELGIUM88 -- Financing model for first-line psychological care 88 -- Financing of specialised psychological care 89 -- The place of the psychiatrist in the system90 -- 9.3 NEED FOR DATA TO CARRY OUT CALCULATION OF COSTS FOR THE FIRST LINE OF PSYCHOLOGICAL HEALTH CARE IN BELGIUM 91 -- Prevalence of mental health problems 91 -- Search for help 92 -- Acceptance of psychological care .92 -- Choice to remain with non-reimbursed psychologist .92 -- 10 DISCUSSION AND CONCLUSIONS 93 -- 10.1 LIMITATIONS 93 -- 10.2 FINAL MODEL .94 -- First line of psychological care 94 -- A second line of more specialized ambulatory psychological care for the people who need it95 10 -- 3 SYSTEM OF FINANCING THE MODEL 98 -- For the first line 98 -- For the specialized care.98 -- “Soft echeloning” to the psychiatrist 99 Economic model 9