Réformes de l'organisation et du financement des soins de suite et de réadaptation : la gestion des paradoxes en réadaptation

The recent reform of healthcare authorizations in France has affected rehabilitation by eliminating the segregation between authorizations for healthcare, on one hand, and physiotherapy and rehabilitation, on the other. Excepting the specific fields of cardiovascular and respiratory rehabilitation, these later correspond to physical medicine and rehabilitation structures including the field of medical rehabilitation which could be called musculoskeletal and neurological rehabilitation. In the context of a new set of standard fees, and the absence of stratification of healthcare needs, the new separation between follow-up care and specialized rehabilitation could place these structures in a vulnerable position. The lack of an integrated healthcare plan has led to fluidity of care reflecting an organization based on short-stay units and healthcare priorities inscribed in the public health code. There is no guarantee that these orientations based on technical conditions and economic considerations are pertinent for groups of patients with homogeneous needs for rehabilitation. The analysis of regional organizations and recent reports from Belgium concerning musculoskeletal and neurological rehabilitation demonstrate the usefulness of developing a patient classification system for France. This classification would be based on the stratification of needs of homogeneous groups of patients corresponding to adequate structures for the healthcare requirements examined from the organizational and economical viewpoint. This would imply a differentiation and necessary complementary mechanisms for integration into the healthcare system.