Azzopardi A1, Busuttil M-L2
1University of Malta, Physiotherapy, Msida, Malta, 2Social Care Standards Authority, Inspectorate Office, Valleta, Malta
Background: The World Confederation for Physical Therapy (2013) describes self-referral as the client's ability to access physiotherapy without a referral note. Studies show that this depends on direct access which is in turn dependent on numerous factors, which led to the main research question; “What is the Maltese health insurances' perspective on direct access measures to private physiotherapy services?”
Purpose: The objectives of this study endeavour to establish the perspective of the health insurance companies on the physiotherapy profession, and to analyse direct access to physiotherapy as conditioned by current structures and procedures implemented for reimbursement by insurance companies.
Methods: The whole population (n=6) of private health insurance companies participated in the research project. A self-designed, structured interview with open-ended questions was developed, piloted and used. The content of the research tool was developed from the policies of health insurances of the Maltese health policy providers.
Results: A 100% response rate was achieved. The main themes that emerged from the findings, through thematic analysis (Braun and Clarke, 2006) were: Terms in Health Insurances, Professionalism and Health Insurance Policy Requirements. The findings presented the various restrictions that exist for reimbursement of physiotherapy services through private health insurance companies in Malta, namely;
1) the required referral note and other documents,
2) the lack of information on the basic rates for one physiotherapy session,
3) the yearly packages,
4) the administrative and settlement measures that reimbursement entails,
5) the fact that physiotherapy was listed under complementary/alternative intervention or as an out-patient benefit that could possibly explain the prohibition of cross-referrals and
6) eligible expenses that are not even reimbursed. Such is the situation that service users' financial needs are not being met or satisfied.
Furthermore, the promotion of physiotherapy benefits is non-existent.
Conclusion(s): To conclude, it is recommended that various research studies should be implemented in the future at a national, European and international level, with the main research purpose to look into the direct access measures that affect reimbursement methods within by private health insurance policies.
Implications: This study could be used as a stepping stone for more in-depth research to be undertaken at international level for further exploration of the themes that were highlighted in this study. Future studies should aim to evaluate the costs of self-referred episodes across insurance companies as this will give a clear indication of the cost-effectiveness of self-referred episodes to physiotherapists. This research has identified some policy gaps that need to be addressed, to assist the Member Organisations of the WCPT in their advocacy measures to improve the health insurance packages. This study also outlines the need to understand further the reimbursement methods for physiotherapy services adopted by private health insurance companies which project could be implemented internationally through involvement of WCPT and Member organisations which could have an important role in compiling the national health coverage data.
Keywords: Direct access, Physiotherapy, Health Insurances
Funding acknowledgements: None as this is a dissertation submitted in partial fulfilment for the degree of Bachelor o Science (Honours) in Physiotehrapy
Purpose: The objectives of this study endeavour to establish the perspective of the health insurance companies on the physiotherapy profession, and to analyse direct access to physiotherapy as conditioned by current structures and procedures implemented for reimbursement by insurance companies.
Methods: The whole population (n=6) of private health insurance companies participated in the research project. A self-designed, structured interview with open-ended questions was developed, piloted and used. The content of the research tool was developed from the policies of health insurances of the Maltese health policy providers.
Results: A 100% response rate was achieved. The main themes that emerged from the findings, through thematic analysis (Braun and Clarke, 2006) were: Terms in Health Insurances, Professionalism and Health Insurance Policy Requirements. The findings presented the various restrictions that exist for reimbursement of physiotherapy services through private health insurance companies in Malta, namely;
1) the required referral note and other documents,
2) the lack of information on the basic rates for one physiotherapy session,
3) the yearly packages,
4) the administrative and settlement measures that reimbursement entails,
5) the fact that physiotherapy was listed under complementary/alternative intervention or as an out-patient benefit that could possibly explain the prohibition of cross-referrals and
6) eligible expenses that are not even reimbursed. Such is the situation that service users' financial needs are not being met or satisfied.
Furthermore, the promotion of physiotherapy benefits is non-existent.
Conclusion(s): To conclude, it is recommended that various research studies should be implemented in the future at a national, European and international level, with the main research purpose to look into the direct access measures that affect reimbursement methods within by private health insurance policies.
Implications: This study could be used as a stepping stone for more in-depth research to be undertaken at international level for further exploration of the themes that were highlighted in this study. Future studies should aim to evaluate the costs of self-referred episodes across insurance companies as this will give a clear indication of the cost-effectiveness of self-referred episodes to physiotherapists. This research has identified some policy gaps that need to be addressed, to assist the Member Organisations of the WCPT in their advocacy measures to improve the health insurance packages. This study also outlines the need to understand further the reimbursement methods for physiotherapy services adopted by private health insurance companies which project could be implemented internationally through involvement of WCPT and Member organisations which could have an important role in compiling the national health coverage data.
Keywords: Direct access, Physiotherapy, Health Insurances
Funding acknowledgements: None as this is a dissertation submitted in partial fulfilment for the degree of Bachelor o Science (Honours) in Physiotehrapy
Topic: Professional issues
Ethics approval required: Yes
Institution: Faculty of Health Sciences
Ethics committee: University Research Ethics Committee - University of Malta
Ethics number: 068/2017
All authors, affiliations and abstracts have been published as submitted.
