Page 166 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Valorisation Addendum
the excess skin on the legs. How this should be measured or assessed is not clear.
Regarding chronic skin conditions, only intertrigo is included as a skin condition that can warrant reimbursement. The intertrigo has to be present for at least 6 months and hygienic measures and topical treatment as stated by the national guideline should have failed to adequately treat the intertrigo 23. According to this national guideline, intertrigo is defined as redness and maceration (saturated with moisture) of skinfolds, with or without infection. However, we showed that in addition to intertrigo, patients also experienced other skin conditions like dermatitis, ulceration and hidradenitis. Moreover, some patients have multiple skin conditions because of the excess skin. This should all be part of the criteria for reimbursement.
In conclusion, the current criteria used for decision making regarding reimbursement of BCS are subjective and therefore, unreliable. In addition, physical and medical complaints are not adequately included. This leads to a daily practice in which pa- tients who do not necessarily need BCS are reimbursed, while patients who do need BCS are not. With the plan below, we want to propose the first step to develop a guideline with complete and objective criteria for reimbursement.
THE PLAN
Healthcare in the Netherlands is organized in a way that spending more on body con- touring procedures means spending less on another part of healthcare. Therefore, we need to improve the way the current budget for BCS is spent, by treating the patients that will benefit most from BCS, have the lowest complication rates and, more impor- tantly, select these patients in an objective manner. The first step is to improve that current system with respect to the inclusion of a complete overview of complaints of excess skin and the improvement of the definition of mutilation.
The plan will involve three parties: the healthcare providers, the patients and the pay- ers (health insurance companies and Healthinstitute of the Netherlands (Zorginstituut Nederland). The Healthinstitute of the Netherlands is a governmental organization that has been giving the task to guard quality, affordability and accessibility of healthcare in the Netherlands. This institute also advises the government on reimbursement of healthcare.
Complete overview of complaints
Several chapters in this thesis have shown that excess skin significantly impacts sev- eral aspects of patients’ well-being. However, not all these aspects are captured in the current criteria for reimbursement. In the last chapter of the thesis we tested a mod- ified version of a screening tool for reimbursement of BCS developed by the British
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