Gaps in delivering publicly-funded physiotherapy across Canada

From Prince Edward Island, to Ontario, to British Columbia; it is getting harder for many Canadians to access publicly funded physiotherapy services. Health care reform initiatives have shifted outpatient physiotherapy into the community, decreasing or eliminating public funding. As a result, Canadians who do not have private health insurance plans and cannot afford to pay for physiotherapy in a private clinic may have to do without much needed treatment, jeopardizing their recovery from surgery, injury and illness.

Even though hospital inpatient and outpatient physiotherapy services are enshrined in the Canada Health Act many hospitals facing budget shortfalls have reduced, closed or privatized outpatient services. In Ontario, for example, 20 hospitals have closed their outpatient services in the last 2 years while many more have downsized services and instituted increased restrictions on eligibility.

"The situation in Ontario is one of the most serious in the country," says Christopher Winn, MSc PT, President of the Ontario Physiotherapy Association. "We understand that these are difficult decisions to make during trying times but they leave the most vulnerable in the population without the necessary services to regain their health. These are people with chronic health conditions who often don't have the means to pay for physiotherapy in a private clinic," adds Winn.

Gaps in the delivery of publicly-funded physiotherapy across Canada are also evident in the high wait times and long wait lists experienced by Canadians in many parts of the country. For example, rural residents on Prince Edward Island who need publicly funded outpatient physiotherapy services may have to wait a year, or even longer in some cases.

"The health care bureaucracy has failed the people of Prince Edward Island who need publicly funded physiotherapy," says Brian Hiscock, BSc PT, LPT, Past-President of the PEI Branch of the Canadian Physiotherapy Association. "Patients are footing their own medical costs. Those who have private insurance plans are lucky, but those that don't and can't afford to pay for physiotherapy often have to live with chronic pain. In many cases they can't work and are relying heavily on medication to deal with their pain," adds Hiscock, a physiotherapist who has lobbied for years for adequate access to publicly funded physiotherapy for all Islanders.

May is National Physiotherapy Month in Canada. The Canadian Physiotherapy Association (CPA) is promoting the value of stable, adequately funded physiotherapy services in all hospitals and outpatient clinics, and advising of the potential for serious consequences associated with reducing or eliminating these services.

"We are facing tremendous challenges in the provision of publicly funded physiotherapy services in Canada," says Alice Aiken, PT, PhD, President of the Canadian Physiotherapy Association. "Our population is aging and that means there are more and more people living with chronic health conditions that require physiotherapy."

"Limiting access to publicly funded physiotherapy services can affect health outcomes for all Canadians, not just seniors," adds Dr. Aiken. "Studies show the effectiveness of getting timely physiotherapy treatment for many acute and chronic health conditions." Physiotherapy has been proven to reduce pain, improve mobility, return patients to functional independence, improving quality of life.

Reducing access to physiotherapy can also increase costs to the health care system. Early assessment and treatment of musculoskeletal conditions by a physiotherapist can reduce the number of visits to doctors, referrals to specialists and prescriptions of medication. Physiotherapy intervention may also delay or eliminate the need for surgery, and help shorten hospital stays.

"The value of physiotherapy in public practice settings must be better understood," says Dr. Aiken. "Physiotherapists are highly trained primary health care professionals who work as part of inter-professional teams in hospitals and outpatient clinics providing the very best care to patients. Hospitals, local health authorities, and provincial governments must recognize that cutting back on physiotherapy will add to their costs in the long term, putting additional strain on an already overwhelmed health care system," adds Dr. Aiken.

Buoyed by its first ever national advertising campaign, CPA will continue to advocate for better access to physiotherapy, both in public and private health care facilities, making Canadians more aware of physiotherapy's value in the health care continuum.