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Improvement of reimbursement for autologous tissue breast reconstruction via convention between INAMI and hospitals
Each year about 1,500 women in Belgium undergoes breast reconstruction using an autologous tissue. The healthcare insurance reimbursed this intervention. However, it was insufficient to cover major surgery, which can last up to 9 hours. The women involved in this form of breast reconstruction, therefore, had to pay extremely high fees. The negotiations have been lasting since 2013 because it was difficult to determine a reasonable fee for the surgeons who carry out such operations. The Belgian Health Care Knowledge Centre (KCE) addressed this issue in the report “Breast Cancer Reconstruction: What Fees Would be Reasonable?”.
A Convention “Agreement between the National Institute for Health and Disability Insurance (INAMI-RIZIV) and listed hospitals on the reimbursement for the total uni- or bilateral breast reconstruction” has been finally approved on October 24, 2016, and by the end of 2016, nearly 60% of the centers had joined this convention. Currently, all the centers that carry out such interventions have adhered to the convention.
Reimbursement for the autologous tissue breast reconstruction can be obtained under the following conditions:
- Following radical surgical treatment of breast cancer;
- Following a preventive mastectomy due to a genetic predisposition to breast cancer;
- In specific cases, after the prior agreement of the College of Medical Directors (see Article 3 of the Convention).
In term of the Convention current medical and reimbursement fees are almost doubled. The part previously attested as a supplement payable by the patient is now covered by the INAMI via the Convention. For surgeons, this proposal is budget neutral.
See full details in the French language here.
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