SETTING Ontario Québec N&L PEI Nova Scotia New Brunswick Hospital Inpatient Covered by public insurance Covered by public insurance Covered by public insurance Covered by public insurance Covered by public insurance Covered by public insurance Outpatient Covered by public insurance where available (department closures, significant regional variation, strict eligibility criteria) Covered by public insurance (strict eligibility criteria) Covered by public insurance (strict eligibility criteria) Covered by public insurance Covered by public insurance; regional variability in wait times and patients encouraged to use private insurance first, with public coverage for treatment when private funding runs out. Covered by public insurance. Cannot refuse anyone; however, there are lengthy waitlists, and patients are encouraged to use private coverage first (this cannot be enforced) Community* Community (Clinic-Based) 259 Community Physiotherapy Clinic contracts – now located in all regions of the province (up from 94 in 2011) Eligibility restrictions remain as previous (19 and younger, 65 and older, social programs, after overnight hospital stay) No physiotherapy services available through non-hospital clinics, public insurance coverage for over 65 No physiotherapy services available through clinics No physiotherapy services available through clinics Central Zone (formerly Capital Health District) has physiotherapists working in community health teams with a strong chronic disease self-management model. Regional variation in access to physiotherapy in a primary health care team outside of Central Zone. There are a few local health centres, but not all have physiotherapy in place. These cut down on travel for those who live in rural communities. Primary Health Care (PHC) 32 Community Health Clinics (CHC) 2 Aboriginal Health Access Centres (AHACS) 17 Family Health teams (FHT) and 2 Nurse Practitioner Led Clinics (NPLC) for a total of 53 PHC settings up from 8 in 2011.
Home Care Community Care Access Centres provide home care physiotherapy (strict eligibility criteria) Coverage for services based on needs and income Limited coverage through health regions based on income, regional variation) Home care physiotherapy sparsely available (significant rural/urban variation) Coverage through Home Care Service (free for low income beneficiaries) Coverage through Hospital Extra-Mural Program is part of provincial health coverage and available to those who are homebound or those whose treatment is better provided in a natural environment (e.g. in school for pediatric clients) Major Gaps Lack of community care options, restricted out-patient criteria, lack of departments, (Physiotherapy now funded in PHC settings since reform see above) Reliance on private insurance, restricted out-patient criteria, lack of physiotherapists Lack of specialized services, lack of home care options, poor long-term care options, geographic variation in care Lack of physiotherapists, low pay of physiotherapists, geographic variations in care, lack of community care options HR challenges consistent across province. Rural hospitals face recruitment challenges; Outpatient clinics have long wait lists and lack human resources to achieve desired intensity of rehabilitation; focus on in-home safety assessments and caregiver education in the home care sector; and, major gaps in access in long term care. Lack of chronic care focus, lack of physiotherapists, geographic variations in care. Long term care facilities provide a “consultation” service by an extra-mural physiotherapist. Physiotherapists are clustered in urban areas; it is more difficult to provide/access service in rural and remote areas. Physiotherapists are not included in primary health care teams, emergency departments or to prevention/wellness *"Community Care" defined as publicly-funded clinic and home-based care SETTING Manitoba Saskatchewan Alberta BC Nunavut/NWT Yukon Hospital Inpatient Covered by public insurance Covered by public insurance Covered by public insurance Covered by public insurance Covered by public insurance
Outpatient Covered by public insurance Covered by public insurance (strict eligibility criteria) Covered by public insurance (strict eligibility criteria) Covered by public insurance (department closures, regional variations) Covered by public insurance (strict eligibility criteria) Community* Community (Clinic-Based) No publicly funded physiotherapy clinics in the community. Limited coverage through Community Therapy Services (CTS) with strict eligibility criteria, regional variation. 3 community clinics and 5 out of 12 health regions provide contracted community services Contracted community services (significant regional variation) Premium Assistance MSP (10 visits/year, $23/visit) Regional Rehabilitation Teams funded through Regional Health Authorities provide community and home care through hospitals (acute care facilities, and regional community outreach clinics) Home Care CTS only provides community service in the Winnipeg Regional Health Authority. Other health authorities have limited home care physiotherapy. OTs do home visits in rural areas. Limited coverage (significant regional variation) Provincial Home Care Program, often requires based on income ($300/month maximum Offered through health regions (eligibility criteria, wait lists, monthly co-payments based on income) Major Gaps Lack of chronic care focus, geographic variations. Patients fund their own equipment if it is not covered by Home Care or EIA. Physiotherapists provide limited service to some northern First Nations communities. Reliance on private insurance, lack of departments, lack of prevention focus, geographic variations Lack of primary care options, lack of prevention focus, lack of long-term care options Lack of community care options, reliance on private insurance, lack of out-patient departments Lack of chronic care focus, lack of community care options, lack of physiotherapists, geographic variations *"Community Care" defined as publicly-funded clinic and home-based care