Access to physiotherapy after Dutch reimbursement changes in the period 2004–2005.

Background: Physiotherapy plays an important role in Dutch primary care. In 2005, 17% of the Dutch people contacted a physiotherapist. To deal with rising health care expenditures, Dutch government has decided to change public insurance coverage for physiotherapy. Until 2004, people with public insurance (66% of the population) were covered for nine treatment visits per complaint. On 1 January 2004, this situation changed and people had to obtain private insurance cover for physiotherapy. Only patients with chronic conditions were still (partly) covered by public insurance. The aim of the current study was to investigate the effects of this measure on patients’ accessibility to physiotherapy. Methods: Data from the National Information Service for Allied Health Care (NISAHC) were used. NISAHC is an electronic registration network based on physiotherapists’ medical records in which ±100 Dutch physiotherapists working in private practices all over the country participate. These therapists register data on their patients, referrals, complaints, treatments, and results. For the current study, data on over 700 000 treatment visits were used. Results: The reimbursement changes of 2004 resulted in less patients visiting physiotherapists during 2004, which resulted in a 6% decrease of the number of treatment visits per practice (95% CI ¼ 2.6–9.6%). In addition, in 2005 patients ended the treatment twice as much with the reason that it was no longer covered by health care insurance compared with 2004. Furthermore, a substantial shift to patients with a chronic complaint was noticed. In 2005, the level of 2004 was retained. Conclusions: The results showed that the accessibility of physiotherapy had decreased, as less people visited physiotherapists after reimbursement change. This effect was partly intercepted by a shift to care that was still covered. Future investigations should reveal whether essential care is excluded for patients. (aut. ref.