A reimbursement-based historical analysis of primary care physiotherapists practice in an evidence-based and financial perspective during 1984-2008

Jan Magnus Bjordal, professor, Institutt for global helse og samfunnsmedisin, Univer-sitetet i Bergen. Professor II, Senter for kunnskapsbasert praksis, Høgskolen i Bergen.
Jan.bjordal@igs.uib.no. 

Hildegunn Lygren, førstelektor, Institutt for ergoterapi, fysioterapi og radiografi, Høgskolen i Bergen.

Ingvill Fjell Naterstad, stipendiat, Institutt for global helse og samfunnsmedisin, Universitetet i Bergen.

Sturla Haslerud, stipendiat, Senter for kunnskapsbasert praksis, Høgskolen i Bergen.

Jón Joensen, førsteamanuensis, Institutt for ergoterapi, fysioterapi og radiografi, Høgskolen i Bergen. Forsker, Institutt for global helse og samfunnsmedisin, Universitetet i Bergen.

Abstract

Research question: Has primary care physiotherapists changed their pattern of reimbursement , and are these changes correlated to financial or scientific changes in reimbursement rates and frequencies ?

Design:  Longitudinal study with descriptive statistics analysis

Method: Historical development of reimbursement rates and their correlation with their respective reimbursement frequencies. 

Material: Historical data for reimbursement rates from 1988 to 2008, and reimbursement frequencies from 1998 to 2008.

Results: This analysis shows that physical therapists examine less and deliver less individual treatment than before. Nearly one in four patients is now treated in groups. Major changes (>20%) in reimbursement rates were significantly associated with changes in clinical physiotherapy practice. Regulatory intervention stopping overlap between patient treatments, resulted in fewer treatments delivered per physiotherapist.

Conclusion: Primary care physiotherapists changed their practice to less individual examinations, less individual and physical modality treatments towards increased use of group exercise treatments. Major changes in reimbursement rates seemed to initiate shifts in treatment preferences. Our data suggest an evolution of two distinctly different physiotherapist roles in primary care; the autonomous examiner/therapist working on an individual patient/therapist basis, and the exercise therapy group instructor. The physiotherapy profession may need to clarify what role future primary care physiotherapists should possess.

Keywords:Physiotherapists with agreement with the local council, practice, primary health care, reimbursement

Full article in Norwegian.