Overview

Key messages:

• Rehabilitation services help patients with the loss of function and independence, reducing long-term burdens on health and social services. They are increasingly important as populations age and in the face of conflict-related injuries.
• Rehabilitation services are inevitably fragmented but integration and coordination can overcome the gaps in continuity and patient-centred care.
• Shifting services to primary care and outpatient settings reduces costs and improves access and efficiency – provided it is adequate to patients’ needs.
• Investing in digital platforms for remote consultations is particularly useful in remote or underserved areas.
• Coordination strategies support effective rehabilitation and reduce unnecessary care. International experience suggests that helpful approaches include:
  • Allocating dedicated case managers to steer patients through the system.
  • Ensuring rehabilitation and primary care professionals work together.
  • Planning hospital discharge processes with continuity of care in mind.
  • Developing adequate data infrastructure to share information and results.
• Coordination takes time and effort. Policies and payment systems need to recognize this.
• Coverage and eligibility criteria ensure access but can also set limits and direct care to the most appropriate and cost-effective setting.
  • Vulnerable populations and patients with intense needs require extended coverage.
  • National guidelines for eligibility can reduce variations in care.

  • Delegating eligibility decision-making to health professionals ensures treatment can be adapted to patients’ needs.

• Financing of rehabilitation is often fragmented, leading to inefficiencies.
  • Pooling of funds from different ministries and sectors makes for more coherent, coordinated and better value care.
  • Planning and purchasing services based on projected population needs, rather than historic use, helps ensure resources are allocated where they will be needed most.
• Using a mix of payment strategies can purchase care more effectively
  • Cautious contracting can regulate quality, volume of services and contain costs.
  • Adjusting the payment system (e.g. bundling payments) can create incentives for providers to admit and treat more appropriately.
  • Making explicit payments for coordination tasks and roles can also enhance performance.
• Aligning payment models with policy goals and context requires careful design and robust data systems to monitor and evaluate outcomes.