Help for children: health insurance funds to cover costs of sports prosthetics
Children who have lost a limb but remain actively engaged in sports will soon be able to receive additional thigh and lower leg prosthetics adapted for sports, covered by the Compulsory Health Insurance Fund (CHIF). The Compulsory Health Insurance Council has approved the inclusion of these orthopaedic devices in the list of reimbursable items.
As early as the third quarter of this year, sports prosthetics will become available to children who need them to fully participate in physical activities.
“We are pleased to contribute to real help for children who, despite physical challenges, lead active lives, participate in sports, and engage in community activities. Until now, sports-adaptive prosthetics for children were not reimbursed in Lithuania, and their cost often exceeded what families could afford. This decision will not only give children greater freedom of movement but also help them better integrate into physical education classes and enjoy more active leisure time,” says Giedrius Baranauskas, Head of the Medical Devices Reimbursement Division of the National Health Insurance Fund (NHIF).
Two new types of leg prostheses for children will be added to the list of orthopedic devices reimbursed by the fund: a thigh prosthesis with a knee joint and active foot, and a lower leg prosthesis with an active foot. These prostheses are specifically designed for children, who play sports, and are made from materials that ensure greater freedom of movement and durability. It is estimated that around 12 children per year, identified as having a high level of mobility – meaning they are active and independent – may require such lower leg and thigh prostheses.
The reimbursable cost of a sports-adaptive thigh prosthesis exceeds EUR 16,000, while that of a lower leg prosthesis is over EUR 9,500. The new prostheses for children will be fully (100%) reimbursed. It is estimated that annual expenses for covering the production and fitting of these prostheses will amount to around EUR 127,000. This year, EUR 60,000 has already been allocated from the fund for this purpose.
To ensure that the prostheses are provided only to children who truly need them, several additional eligibility criteria will apply. Pediatric sports prostheses may be prescribed only by a medical council at a tertiary-level healthcare institution, which must include a physician specializing in physical medicine and rehabilitation, as well as an orthopedic traumatologist. A recommendation from an orthopedic technologist will also be required, along with a document from an educational or extracurricular institution confirming that the child participates in physical activity.
Additionally, one of the parents must sign a commitment to provide appropriate conditions for the child to engage in sports and to encourage child’s physical activity.
This year, nearly EUR 18 million has been allocated for the reimbursement of orthopedic technical aids, of which EUR 6.6 million from the fund is designated specifically for limb prostheses.
(Illustration: AI-generated image)
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