RESEARCH REPORT PLATFORM PRESENTATION

DELISTING PUBLICLY-FUNDED COMMUNITY-BASED PHYSICAL THERAPY SERVICES IN ONTARIO, CANADA: A 12-MONTH FOLLOW-UP STUDY. Paul J¹, Park L¹, Ryter E¹, Miller W¹, Ahmed S¹, Landry M², Cott C²; ¹Department of Physical Therapy at the University of Toronto, Toronto, Canada. ²Department of Physical Therapy at the University of Toronto, and The Arthritis Community Research and Evaluation Unit, Toronto, Canada

PURPOSE: Publicly-funded community-based physical therapy (PT) services in Ontario were partially delisted in April 2005. This study is a 12-month follow up to previous studies that assessed short-term consequences of the delisting. This follow up aimed to assess the long-term consequences of the policy decision from the perspectives of both PT providers and clients in Ontario. RELEVANCE: Reducing expenditures on publicly-funded health services has become necessary as health care costs are increasing. Examining the consequences of the delisting provides substantiation of its impact on both clients and the PT profession, which may help direct future policy decisions. PARTICIPANTS: Sixteen provider participants (89%) were recruited from the 18 providers who participated in a previous provider study regarding the delisting and who agreed to be contacted for follow up. These providers worked in one of four practice categories: (1) publicly-funded, community-based clinics (termed Designated Physiotherapy Centres), (2) privately-funded clinics, (3) hospitals, or (4) home care under contract with Community Care Access Centres. Sixty-four client participants (65%) were recruited from the 98 clients who participated in a previous client study regarding the delisting and who agreed to be contacted for follow up. These clients had been accessing publicly-funded, community-based PT services prior to the delisting. METHODS: At 12 months following the partial delisting, provider and client participants completed a 10 minute telephone interview that included both quantitative and qualitative components. ANALYSIS: Quantitative data from participant interviews were systematically analyzed using descriptive statistics. Qualitative data from provider interviews were entered into a data analysis software package, and major themes derived from the data were subsequently analyzed. RESULTS: At 12 months follow up, 28 of 37 (76%) client participants considered ineligible for publicly-funded, community-based PT, reported increased difficulty accessing PT services. Several of these clients also expressed health concerns. A decrease in demand for PT was reported by providers at Designated Physiotherapy Centres, whereas most providers in other settings reported no change resulting from the delisting. Providers reported that clients were increasingly using other publicly-funded health care services after the partial delisting. Lastly, there were mixed perceptions regarding the impact of the delisting on the PT profession in Ontario. CONCLUSIONS: Long-term consequences of the delisting were not significantly different from short-term effects identified two weeks after the policy implementation. Follow-up results indicate that clients requiring PT services in publicly-funded, community-based settings are unable to access services elsewhere. Further research is required to assess the cost-effectiveness of shifting fiduciary health care responsibility away from the provincial government and moving it towards private and third-party payers. Research into innovative resource allocation methods is needed to sustain public health care systems. IMPLICATIONS: Documentation and dissemination of these results will help inform the PT profession in Ontario, as well as stakeholders in other jurisdictions who may face similar policy changes. Failure to remodel health policy to meet emerging demands may ultimately shift the Canadian health care paradigm away from equal access. KEYWORDS: Delisting, Health Policy, Public Funding. FUNDING ACKNOWLEDGEMENTS: Medicare to Home and Community (M-THAC) Research Unit at the University of Toronto, Ontario Physiotherapy Association, Ontario Physiotherapy Association – Hamilton District, Ontario Physiotherapy Association – Central Toronto District, Physiotherapy Association of British Columbia, Alberta Physiotherapy Association, Toronto Rehabilitation Institute and the Arthritis Community Research and Evaluation Unit.

ETHICS COMMITTEE: The University of Toronto Health Sciences II Research Ethics BoardThe University Health Network