PHYSIOTHERAPY & HEALTH

Current Issues

As part of its mission to improve the affordability and access of all Australians to physiotherapy services that meet their needs, the APA takes an active role in public debate on health and related issues affecting physiotherapists and their patients.

1. Medicare

No single health profession should have a monopoly on public healthcare funding. Where there is evidence that a particular treatment is the most effective and cost-effective, this treatment should be funded by Medicare, irrespective of which health profession provides the service.

• Diagnostic Imaging

Currently, referrals to x-ray made by physiotherapists attract a lower Medicare rebate than referrals from GPs, an inequitable arrangement that forces ordinary Australians to visit a GP simply to attract a full rebate for an x-ray service. The APA has estimated savings of over one million dollars a year to Medicare if referrals from physiotherapists and GPs attract the same rebate. The APA will continue to lobby for this change.

• Extending Medicare to Physiotherapy

In 2004 the APA successfully lobbied the federal government to extend Medicare to physiotherapy services, but the APA remains concerned that limiting the funding of physiotherapy services to those patients with chronic and complex conditions (Enhanced Primary Care Plans, on referral from a GP) leaves many needy patients still unable to access the care they need. Many of those eligible under this model of care require more physiotherapy than the five visits per year currently funded. The government has mooted changes to the scheme and the APA will continue to argue for patients to have timely, affordable access to the care they need.

The APA continues to seek the establishment of Medicare Benefits Schedule (MBS) item numbers for the physiotherapy management of conditions such as stress incontinence and knee joint osteoarthritis – conditions where there is strong evidence of the effectiveness and cost-benefits of physiotherapy over medical and surgical treatments.

2. Physiotherapy Education

Physiotherapy is a clinical discipline not acknowledged by current levels of federal education funding (under the Commonwealth Grants Scheme). Under-graduate courses in physiotherapy need to be funded at a level at least comparable to that of nurses, to allow for funded clinical placements in hospitals and other facilities.

There is a looming crisis in physiotherapy education and urgent attention is needed to: increase base funding levels; support students on clinical placements; and, increase the supply of clinical placements.

Investment in innovative models of clinical education is essential.

3. Strengthening the Workforce

There is a critical shortage of physiotherapists across Australia, particularly in rural and remote localities and in some specialised areas including oncology, paediatrics and gerontology.

There are more physiotherapists graduating each year yet the need for physiotherapy skills is still not being met. There is a critical need for a comprehensive study of the supply of and demand for physiotherapy skills.

• Extended Scope Practice

A physiotherapy extended-scope practitioner is a clinical specialist who has the opportunity to develop and demonstrate expertise beyond the currently recognised scope of practice.

Extended scope physiotherapy in the UK is now commonplace in the delivery of both primary and secondary care musculoskeletal services. Physiotherapist duties now often include case management previously reserved for orthopaedic and rheumatology consultants, ordering and interpreting of diagnostic tests (such as scans, x-rays and blood tests), administering certain injections, and directly listing patients for surgery.

The legislative framework of Australia’s health system doesn’t currently allow physiotherapists to undertake extended scope roles such as those in the UK.

The APA continues to lobby for reform to the national health system to allow physiotherapists to fully employ their clinical reasoning abilities, which would relieve the burden on the medical workforce and reduce waiting time for patients before receiving suitable treatment. It would also provide career paths for physiotherapists and help maintain workforce numbers.

4. Primary Health Care

Preventive interventions reduce the risk of illness and injury, thus reducing the social and economic cost of poor health in the community.

Physiotherapists believe the low priority given to research and implementation of preventive care is short sighted. The APA contends that preventive health care is essential and should be a high priority in health funding. The APA will work to promote commitment to research and implementation of the most effective preventive strategies to improve health outcomes.

5. Health Reform

Our health system is in need of major reform. With the State/Federal funding divide leading to major inefficiencies, and the inefficient utilisation of the health workforce, the system must focus more on primary care and extending the scope of professional practice beyond traditional boundaries. Reform of this nature in the UK allows health professionals to fully apply their clinical abilities, relieve the burden on the medical workforce and reduce waiting time for patients before receiving suitable treatment.

To progress reform, the APA is a member of the Australian Health Care Reform Alliance (AHCRA). One of the key principles guiding the AHCRA is supporting citizen engagement in health reform. The APA is committed to working with AHCRA to persuade governments to involve citizens in reform decisions and to implement the recommended reforms.