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Wojkowski S1, Richardson J1, Birch S2,3, Boyle M1
1McMaster University, Hamilton, Canada, 2University of Queensland, Brisbane, Australia, 3University of Manchester, Manchester, United Kingdom
Background: The Canada Health Act (CHA) applies to the delivery of physiotherapy services (PTS) in Canada only in relation to necessary in-hospital physiotherapy for patients.Over the last four decades, the delivery and coverage of PTS has changed in response to changes in medical practice, society and fiscal constraints. These changes included the decision to remove, in part or whole, physiotherapy from the list of publicly funded health services by some provinces in Canada (delisting). Delisting services from provincial health plans can create naturally occurring health policy experiments that present opportunities to explore policy decision consequences by comparing pre- and post delisting periods. Understanding the effect of delisting services on the quantity and distribution of care is important. Governments face continued fiscal pressures and must contemplate further reductions in publicly funded health services to meet fiscal demands.
Purpose: To investigate if the policy decision to partially remove physiotherapy services (PTS) from OHIP ('delisting') resulted in an increase in unmet need for physiotherapy by Ontario residents immediately following and more than ten years after implementation.
Methods: Semi-structured interviews with six key informants with expert knowledge about partial delisting of PTS in Ontario were completed. Transcripts were coded using directed content analysis and a priori codes of availability, affordability and acceptability. Themes were identified for each research question.
Results: The majority of informants identified unmet need occurred immediately following partial delisting of PTS in Ontario. The most common reasons identified for unmet need were reductions in availability and affordability of PTS. Additionally, unmet need for PTS was identified to exist in the present day, more than ten years following partial delisting. Affordability and availability continued to be perceived as main reasons why unmet need for PTS persists.
Conclusion(s): The policy decision to partially delist PTS resulted in an unintentional consequence of unmet need for specific groups in the Ontario population. This unmet need continues to exist today, despite additional policy changes that have occurred since partial delisting.
Implications:
· The change from full to partial delisting in 2005 minimized changes in unmet need post delisting for some populations.
· Marginalized populations who do not meet access criteria for publicly funded, community based PTS remain most at risk for unmet need
· Further research is warranted to fully understand the present status of unmet need for physiotherapy in Ontario, and how this unmet need may be contributing to other public health crises.
Keywords: physiotherapy, delisting, unmet need
Funding acknowledgements: none
Purpose: To investigate if the policy decision to partially remove physiotherapy services (PTS) from OHIP ('delisting') resulted in an increase in unmet need for physiotherapy by Ontario residents immediately following and more than ten years after implementation.
Methods: Semi-structured interviews with six key informants with expert knowledge about partial delisting of PTS in Ontario were completed. Transcripts were coded using directed content analysis and a priori codes of availability, affordability and acceptability. Themes were identified for each research question.
Results: The majority of informants identified unmet need occurred immediately following partial delisting of PTS in Ontario. The most common reasons identified for unmet need were reductions in availability and affordability of PTS. Additionally, unmet need for PTS was identified to exist in the present day, more than ten years following partial delisting. Affordability and availability continued to be perceived as main reasons why unmet need for PTS persists.
Conclusion(s): The policy decision to partially delist PTS resulted in an unintentional consequence of unmet need for specific groups in the Ontario population. This unmet need continues to exist today, despite additional policy changes that have occurred since partial delisting.
Implications:
· The change from full to partial delisting in 2005 minimized changes in unmet need post delisting for some populations.
· Marginalized populations who do not meet access criteria for publicly funded, community based PTS remain most at risk for unmet need
· Further research is warranted to fully understand the present status of unmet need for physiotherapy in Ontario, and how this unmet need may be contributing to other public health crises.
Keywords: physiotherapy, delisting, unmet need
Funding acknowledgements: none
Topic: Globalisation: health systems, policies & strategies
Ethics approval required: Yes
Institution: McMaster University
Ethics committee: Hamilton Integrated Research Ethics Board
Ethics number: Project Number 2519
All authors, affiliations and abstracts have been published as submitted.
