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30 APPENDICES Physiotherapy KCE reports vol. 40 5.2. EXPENDITURE, AND UTILISATION OF PHYSIOTHERAPY SERVICES IN AMBULATORY CARE 5.2.1. Utilisation of services by the population Table 1. Contacts with physiotherapists in primary care setting % persons with contact N contacts, per person 2002 17,2 2,8 16,3 2003 17,6 3 17,2 2004 17,3 2,9 16,8 Source: CBS (Centraal Bureau voor de Statistiek) Mean N contacts, per person having a contact From 2002 data it can be extrapolated that there were a total of 45 million contacts with primary health care physiotherapists in that year. This is equivalent to 3,600 contacts per active physiotherapist and 4,000 per full-time-equivalent (FTE) (3). 5.2.2. Expenditure for primary health care physiotherapy The expenditure on physiotherapy in PHC was estimated to 676 millions euros (2002) (3). 5.3. HOW ARE PHYSIOTHERAPISTS PAID: WHICH FEES FOR WHICH SERVICES 5.3.1. Basic fee Physiotherapists in ambulatory care work for a fee-for-service. The basic service unit is the 25minute session, whatever the treatment modalities. If the session lasts longer than 25 minutes, there is the possibility to bill 2 consecutive sessions for the same patient. Recognized specialists (like paediatric physiotherapists) can charge more. The list of basic unit fees also includes travel allowances (if the session takes place at home, or in a nursing home), a different (higher) fee for a complete physiotherapeutic diagnosis, and a few other possibilities. Overall, this list of basic fees is extremely simple. Fees used to be regulated; the maximum fee for a 25-minute session was 20.5 euros in 2002. An experience is now taking place whereby fees are completely deregulated; this experience will be evaluated after 2 years. In practice fees are negotiated with insurance companies. Price per session is now around 24 Euros (2004). 5.3.2. Who prescribes, who decides the length of treatment Since a recent reform the patient has the possibility of direct access to the physiotherapist; this has also been accepted by the insurance companies. However, whether the patient is referred by a doctor or not, the physiotherapist is the one deciding on the number of sessions needed. In practice a great deal of physiotherapy in primary care setting is paid for by private insurances, and most contracts with insured persons simply stipulate a fixed ceiling for the number of sessions and/or the cost of physiotherapy that could be refunded to the insured person per year, whatever his or her problem(s).
KCE reports vol.40 APPENDICES Physiotherapy 31 On the other hand health insurers want to pay the providers they contract per product . Only one large company (Agis) has so far defined some products for physiotherapy. This takes the form of protocols (such as 1333 Euros for treatment of COPD/Ashtma, groups of 8 patients, over a 3month period. These protocols can be found on its website 10 . 5.4. PHYSIOTHERAPISTS AND THEIR ACTIVITIES 5.4.1. Who can practice physiotherapy in the NL? To qualify as a physiotherapist requires four years of full-time higher vocational education in a recognized school. There are 10 public, and one private such school. An admission quota (1,054 students per year for all public schools) was lifted in 2000. Admissions the following year went up to 1,787 (3). Qualified physiotherapists need to be registered in a centralised, so-called BIG (Beroepen in de Individuele Gezondheidszorg) register. Physiotherapists are free to set up in practice wherever they wish. However it is difficult for them to run a profitable practice without a contract with a health insurance. 5.4.2. Number of physiotherapists, and distribution In 2003, there were 32,668 physiotherapists in the BIG register (3). Of these 13,254 were working in a primary health care practice, providing a total of 12,250 full-time equivalent (FTE) of physiotherapy. The number of inhabitants per active primary health care physiotherapist (FTE) was 1,322. Out of all physiotherapists in primary health care, 62% were self-employed (in solo or group practices) and 38% had a salaried employment for a practice owner. It is important to stress that a distinction is made between physiotherapists and manual therapists (manuele therapeuten). The latter group consists of physiotherapy graduates with a subsequent specialisation in manual therapy techniques. Currently there are some 2.600 manual therapists. 5.4.3. Description of activities 11 Data are available from the physiotherapist surveillance network (see further: Health Information System) (4, 5). See annex for more details. - place: for the publicly insured 15 % of the sessions in 2004 took place outside the physiotherapy practice (home, or nursing home) - diagnosis : the most frequent 3 diagnosis accounted for +/- 30 % of all treatment episodes (2004): Lage rugpijn zonder uitstraling; Nek symptomen/ klachten, Rug symptomen/ klachten - number of sessions: (2003) : considering only publicly insured patients, mean number of sessions per treatment episode was around 12 sessions for the most frequent reasons for treatment (back pain) ; and 32 sessions (in a year) for patients suffering from a list problem (list of chronic diseases, allowing a higher number of sessions per year). 5.5. QUALITY ASSURANCE AND EVALUATION SYSTEMS The Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap Fysiotherapie, KNGF) is the only professional organisation for physiotherapists in the Netherlands. Important among its mandates is the promotion of quality. 10 http://www.agis.web.nl/ zorgverleners fysiotherapists 11 Data collected before the major reforms in 2004 and 2006 might not reflect the present reality.
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