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10 APPENDICES Physiotherapy KCE reports vol. 40 Over 9000 physiotherapists are member (on a voluntary basis) with the Canadian Physiotherapy Association (CPA), a national professional organisation. 2.2.3. Practice Physiotherapists work in a variety of settings, both private and public, such as health clinics, hospitals, rehabilitation centres and nursing homes (2). Generally, physiotherapists receive salaried pay, although private practices may work on a fee-for-service basis. 2.3. CONDITIONS FOR COVERED SERVICES Under the provisions of the Canada Health Act, while in hospital physiotherapy services are publicly funded and free of charge. In Ontario, the Canada Health Act is implemented by the Ontario Health Insurance Plan (OHIP). No premiums are to be paid for OHIP coverage. Three criteria determine general eligibility for OHIP coverage (3): One must be a Canadian citizen or landed immigrant or refugee. One must have one s permanent and principal home in Ontario. One must be present in Ontario for at least 153 days in any twelvemonth period. Five specific criteria determine eligibility for OHIP coverage of physiotherapy care in ambulatory care: Treatment must be ordered by a physician. Patients must be younger than 20 years of age or 65 years of age and older. The patient has been discharged as a hospital patient and needs physiotherapy care for a condition for which he was admitted to hospital. The patient needs in-home services due to his/her condition, illness or injury. The patient is an Ontario Disability Support Program, Family Benefits, or Ontario Works recipient. OHIP will cover physiotherapy services in hospitals and community care centres. As federal contributions to healthcare budgets have steadily declined, however, provincial authorities resorted to cost containment. As a result, long waiting lists now persist for OHIP-covered outpatient physiotherapy services. Many, otherwise OHIP-covered, people therefore purchase physiotherapy care through self-pay or partial coverage by employer-based plans. In Ontario these plans (e.g. the Workplace Safety and Insurance Board) allow for direct access without a prior referral prescription Covered charges, however, typically are limited to a low amount of around 500 CAD (or about 346 ) annually. 2.4. QUALITY ASSURANCE AND EVALUATION SYSTEM 2.4.1. Mandatory Programs Specific accreditation programs for physiotherapy education at academic level are provided by the Accreditation Council for Canadian Physiotherapy Academic Programs (ACCPAP). Another quality guarantee is provided through the nation wide Competency Examination (cf. supra). Regarding practices of established physiotherapists, each province has legislation on the scope of physiotherapy services, ongoing practice/continuing competence and complaint procedures. The College of Physiotherapists of Ontario is the largest regulatory physiotherapy body in Canada. It lays down the mandatory standards for physiotherapy practice. These standards are comprehensive and include among others:
KCE reports vol. 40 APPENDICES Physiotherapy 11 Confidentiality, conflicts of interests, record keeping, etc. Billing procedures, Referral procedures, Supervision of Physiotherapy students, etc. Application of medical guidelines. The College is involved in activities to promote continuing education, but apparently does not impose it as a formal obligation for practising physiotherapy. A striking feature of the college s didactic approach is the real-life application of adopted standards to hypothetical situations (online accessible scenario s). 2.4.2. Voluntary programs The Canadian Council on Health Services Accreditation (CCHSA) is a national independent organisation. As a non-for-profit outfit it grants accreditation to health services that pass its quality standards. Among others, its program covers rehabilitation services and long term care. The twostage procedure encompasses organisational self-assessment and external peer review. Services and methods are held against an established set of national standards. Additionally, specific accreditation programs for physiotherapy services are available through the Canadian Physiotherapy Association. An external assessment of service standards by peer review referees is offered through this program. Individual practitioners have access to continuing education facilities at reduced rates. 2.5. HEALTH INFORMATION SYSTEMS The Canadian Institute for Health Information (CIHI) will start collecting standardized data on active physiotherapists and integrate them into the National Physiotherapy Database , from 2007 in order to analyse the profession to more extensive detail starting 2008. The main purpose of this undertaking is to underpin central manpower planning efforts. 2.6. KEY POINTS Provincial and territorial authorities are the main parties in financing, regulating and delivering health services. Admission criteria for the profession have been harmonized across (most of) Canada and include testing of practical physiotherapy skills. Long waiting lists exist for OHIP-reimbursed physiotherapy care. Many people resort to the self-pay market. For some employment-based complementary insurance schemes direct access (without a prior referral prescription) is allowed. Quality standards are imposed through provincial bodies; they concern both individual practitioners as the organisation of services.
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