TY - JOUR
T1 - Influence of reimbursement policies on phlebological surgical practice in Belgium between 2007 and 2017
AU - Guillaume, Genevieve
AU - Vuylsteke, Marc
AU - Dalcq, Virginie
AU - Van der Borght, Lisbeth
AU - Meeus, Pascal
AU - de Maeseneer, Marianne
N1 - Publisher Copyright:
© 2020 EDIZIONI MINERVA MEDICA.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - BACKGROUND: To date, it is unclear how treatment of patients with chronic venous disease (CVD) is influenced by national reimbursement systems. In Belgium, catheters or fibers used for endovenous thermal ablation (EVTA) are reimbursed only once in a lifetime. The potential impact of the Belgian public health insurance reimbursement policy on surgical practice in phlebology needs to be investigated. METHODS: Billing data available from the Belgian National Institute for Health and Disability Insurance (NIHDI) were used for analyzing the distribution of specific surgical procedures for treating varicose veins and their relative use from 2007 to 2017. The potential influence of age, sex, social status and geographical origin of insured patients on surgical practice in Belgium were studied. RESULTS: The annual intervention rate was 343 per 100,000 insured individuals for 2017 with a slight annual increase over the period 2007-2017 (+ 0.83% per year). Patients with limited resources, benefiting from a preferential reimbursement system, had a significantly lower intervention rate than those having the usual system (P<0.001). There was a large geographical variation in the use of care, ranging from 172 to 549 per 100.000 insured in 2017. The number of classic surgical procedures decreased (-6.17% per year) in the period 2015-2017) while EVTA, newly reimbursed in Belgium since 2012, increased during the same period (+ 3.6% per year). This evolution was more pronounced in the north (Flanders) than in the south (Wallonia) of the country. Bilateral treatment increased considerably from 2012 and stabilized at 33% of all surgical interventions in 2016 and 2017. CONCLUSIONS: Available data of the NIHDI in Belgium highlight remarkable differences in the use of care for CVD, depending on social status and geographical origin of insured patients. The introduction of EVTA techniques has been adopted more rapidly in the north of the country and has led to an increased percentage of bilateral procedures.
AB - BACKGROUND: To date, it is unclear how treatment of patients with chronic venous disease (CVD) is influenced by national reimbursement systems. In Belgium, catheters or fibers used for endovenous thermal ablation (EVTA) are reimbursed only once in a lifetime. The potential impact of the Belgian public health insurance reimbursement policy on surgical practice in phlebology needs to be investigated. METHODS: Billing data available from the Belgian National Institute for Health and Disability Insurance (NIHDI) were used for analyzing the distribution of specific surgical procedures for treating varicose veins and their relative use from 2007 to 2017. The potential influence of age, sex, social status and geographical origin of insured patients on surgical practice in Belgium were studied. RESULTS: The annual intervention rate was 343 per 100,000 insured individuals for 2017 with a slight annual increase over the period 2007-2017 (+ 0.83% per year). Patients with limited resources, benefiting from a preferential reimbursement system, had a significantly lower intervention rate than those having the usual system (P<0.001). There was a large geographical variation in the use of care, ranging from 172 to 549 per 100.000 insured in 2017. The number of classic surgical procedures decreased (-6.17% per year) in the period 2015-2017) while EVTA, newly reimbursed in Belgium since 2012, increased during the same period (+ 3.6% per year). This evolution was more pronounced in the north (Flanders) than in the south (Wallonia) of the country. Bilateral treatment increased considerably from 2012 and stabilized at 33% of all surgical interventions in 2016 and 2017. CONCLUSIONS: Available data of the NIHDI in Belgium highlight remarkable differences in the use of care for CVD, depending on social status and geographical origin of insured patients. The introduction of EVTA techniques has been adopted more rapidly in the north of the country and has led to an increased percentage of bilateral procedures.
KW - Chronic venous disease
KW - Epidemiology
KW - Surgery
KW - Endovenous thermal ablation
KW - Reimbursement
KW - Health
KW - Insurance
KW - Ablation techniques
UR - http://www.scopus.com/inward/record.url?scp=85092679816&partnerID=8YFLogxK
U2 - 10.23736/S0392-9590.20.04305-9
DO - 10.23736/S0392-9590.20.04305-9
M3 - Article
SN - 0392-9590
VL - 39
SP - 267
EP - 275
JO - International angiology
JF - International angiology
IS - 4
ER -