Reports/Docs > Newsletters > December 2009
|
|
|
December 2009
December 2009 Newsletter |
|
Australia |
Yes |
|
Austria |
Generally no. People can access a physiotherapist without prescription for prevention of diseases only, but they do not get payment from the general health care system for that |
|
Belgium |
No. Currently we are busy exploring the possibilities of implementing Direct Access in Belgium. There is a special Work group within the ministry of health which is working out an advisory document for our minister of health, but it will still take some time to have results |
|
Canada |
Yes |
|
Denmark |
Patients can have direct access to a physiotherapist. By law, there is no barrier to seeing patients without a referral but to be able to use the financial support of the national health insurance (covering 40 % of the expenses), there has to be a referral from a medical doctor. Some patients have additional insurance, via their work. Some of these insurances cover (partly) the expenses if the physiotherapist is working without a referral of a medical doctor, which means that the larger part of the Pts in clinics have a contract with the national health insurance. Patients are referred from a medical doctor and their patients have the financial support from this national body. A lesser number of physiotherapists work without a contract with the national health insurance, and patients may or may not have a referral and they may or may not get financial support |
|
Finland |
Patients can have direct access to physiotherapy in private clinics, and in about one year from now in a few public Health Care Centers too |
|
Germany |
Not in the same way as for example in Australia, The Netherlands or Norway. Patients may come for treatment without a prescription. There is however no reimbursement from the health care funds. Most practices will only take patients who have previously come with a prescription from a physician |
|
Greece |
No, they have not |
|
Hong Kong |
No |
|
Ireland |
Yes, in private practice but in public hospitals patients are referred by In house doctors for the most part, although most hospitals have a GP referral system as well |
|
Italy |
Yes, they do, but in general only in private practice: in hospitals they need a visit from a Medical Doctor |
|
Japan |
The Japanese law prohibits direct access. That is, unless a patient receives medical examination or medical instructions, he cannot get physical therapy in Japan |
|
Netherlands |
Yes |
|
New Zealand |
Yes |
|
Norway |
Yes we have direct access for Manual therapists in Norway |
|
Portugal |
No reply |
|
South Africa |
Yes – since 1985 |
|
Spain |
Yes, but only private physiotherapy. Physiotherapists working in the public health system have to have a referral from the national health system |
|
Sweden |
Yes |
|
Switzerland |
No |
|
USA |
Each of the individual states in the U.S.A. is governed by different statutes that dictate the provisions by which medical providers practice. Patients in the United States have directly access to physical therapists in 42 of the 50 states. Some of these states have “unlimited” direct access and others place specific “provisions” on how the physical therapists can utilize direct access. There remain 8 states that have out-dated provisions requiring a referral by a physician, from their statutes |
|
United Kingdom |
Yes and No! There is direct access to private practitioners. Some NHS services are starting self referral/direct access but not all services. There is a move for this to happen |
2. If yes, can all physical therapists / physiotherapists practice in a direct access situation, or do the pts have to have additional training or credentials in order to practice with direct access? Please describe the additional training or credential required.
|
Australia |
No additional training required |
|
Austria |
- |
|
Belgium |
- |
|
Canada |
All physiotherapists have direct access in Canada |
|
Denmark |
There are no demands on special training. Most physiotherapists working without a contract with national health insurance have postgraduate training e.g. Diploma education in Musculoskeletal Physiotherapy, McKenzie, etc, but that is not officially required |
|
Finland |
In private practice no additional training is needed. In the public HC there is an additional training, which is locally organized and varies a little in different parts of Finland - mostly about screening the serious pathology and managing the ”non specific” neck and low back pain |
|
Germany |
- |
|
Greece |
- |
|
Hong Kong |
-
|
|
Ireland |
Yes, all Physios can practice in a direct access situation from graduation |
|
Italy |
There is no credential, all physiotherapists can practice in direct access situations in their own practice. Our professional profile states that physiotherapists could work referring to medical diagnosis, not always as the prescription requires |
|
Japan |
There is no additional training or credential |
|
Netherlands |
At the moment all registered physical therapists have a direct access situation. No additional training is required for students who have just finished his/her study. A few years ago when direct access was allowed by the government every registered physical therapist was obliged to follow a course “direct access” organized by the mother organization. Without this course you were not allowed to have direct access for patients. Especially screening of red flags and contact with other disciplines were main topics in this course. Nowadays all PT’s are registered for direct access |
|
New Zealand |
No additional training is required – as undergraduates (no OMT qualification but registered physiotherapists) they can work and have direct access |
|
Norway |
Manual Therapists are the only physiotherapists in Norway given direct access, after they have obtained a Master in Clinical Manual Therapy (2 years), from the University of Bergen in Norway. Other recognized Master programs in Manual Therapy from other countries may also qualify. Most of those who study abroad are obliged to take (and pass) 2 sections of the education at the University of Bergen, plus a course in relevant parts of the social security system in Norway. They may be required to have 1 year of supervised clinical practice followed by a practical examination to qualify |
|
South Africa |
Yes - all pts |
|
Spain |
In private, there is only a need of having a degree of physiotherapy |
|
Sweden |
No additional training |
|
Switzerland |
- |
|
USA |
No additional training is required in the majority of states with direct access. However, some states place additional requirements such as the physical therapist must hold a master or doctorate degree and has completed at least two years of practical experience as a licensed physical therapist |
|
United Kingdom |
No further training is required |
3. Can physical therapists in your country obtain reimbursement for direct access physical therapy services, or is there a referral needed in order to obtain payment for services from third party or governmental health care insurance?
|
Australia |
Referral required for motor vehicle, workers compensation, national service (army, navy, air force) veterans. Private patients do not, and are still eligible for a rebate under their private health insurance |
|
Austria |
The referral is needed for payment from the governmental health care system |
|
Belgium |
There is no reimbursement without a prescription from an MD in Belgium |
|
Canada |
Payment for services for direct access physical therapy services is made to the physiotherapists. No orders are needed for Canada |
|
Denmark |
See 1. |
|
Finland |
Referral is needed for payment from governmental health care insurance or private insurance companies |
|
Germany |
No. A prescription is need for the health care fund to pay for treatment |
|
Greece |
A referral from the doctor is needed for the physiotherapist to be legal and to get paid from any kind of insurance |
|
Hong Kong |
Referral is required |
|
Ireland |
In private practice, physiotherapy services are paid for by each patient. They can then be reimbursed by their private health insurance if they have this and can claim tax relief of the balance. In the public health care system, all physio services are free |
|
Italy |
Excluding the hospitals in which there is no direct access, in private practice it depends on the insurances. Most of them require a visit from a MD, others do not |
|
Japan |
Payment reimbursement is not allowed |
|
Netherlands |
A direct reimbursement is paid by health insurance companies. No referral is needed |
|
New Zealand |
No referral required |
|
Norway |
The qualified Manual Therapists who have a contract with their local governmental health care service are reimbursed directly by the health care service office. Payment is based on the time used for each patient. The amount (price) of reimbursement is reviewed yearly. Some patients diagnosis qualifies them for free treatment and others must pay a fixed sum for each treatment. The Manual therapist decides the duration of the treatment and the number of treatments required |
|
Portugal |
No reply |
|
South Africa |
All pts in private practice submit claims and are paid directly by medical insurers – without referral. We do not have a governmental health care insurance yet – but it is in the pipeline |
|
Spain |
In the governmental health care insurance the patients must be referred from the doctor |
|
Sweden |
No referral but you need to have a “contract” with the “governmental health care insurance system” and that is hard to get |
|
Switzerland |
A Prescription from a medical doctor is obligatory |
|
USA |
This varies by state and by the type of insurance product or insurance company that the individual patient has. For instance, some insurance plans require a referral to a specialist to be reimbursed and pts are considered specialists. The government healthcare insurance Medicare does not require a referral but requires a “Plan of Care” to be signed by a physician |
|
United Kingdom |
Patient would be logged to their GP and reimbursement would be gained that way. If private, a referral would be required for payment if insurance company is paying, otherwise the patient would pay direct. |
4. Do physical therapists receive training in primary care assessment for screening for serious pathology and disease in their basic physical therapy education, or is this considered an advanced level of training? If considered advanced training, how is the training obtained? (i.e. Through advanced degree programs, certification programs, continuing professional education, or other means)
|
Australia |
Occurs at undergraduate level i.e. Basic training |
|
Austria |
Screening for serious pathology as well as yellow, blue and black flag assessment is incorporated in the basic physical therapy education and embedded in the clinical reasoning process |
|
Belgium |
They already receive training during their basic program in primary care assessment with a focus on differential diagnosis, screening of red flags, clinical reasoning and interpretation of medical imaging. The basic program is at a master level in Belgium. In Flanders the educational structure is 3yr Bachelor degree and 2 years Master degree to become a PT. The advance programs are partially within the basic program (choice of different options in their master, for example musculoskeletal physiotherapy) and partially through PGD programs (at university) or an extra master program. For musculoskeletal physiotherapy – manual therapy there exists both PGD programs (Ghent, Leuven) & a 1 year master program (Brussels) as a 6th year after graduating |
|
Canada |
There is screening for serious pathology and disease in the basic physical therapy education system, which is at a msc level course in Canada |
|
Denmark |
Training on screening for serious pathology is only done at a very basic level in the physiotherapy education. To our knowledge, only our Musculoskeletal Physiotherapy postgraduate education offers courses in screening for serious pathology. These courses are 1 and 2 days courses with medical doctors specializing in medical disease, rheumatology, neurology and orthopaedics. Certification is done via an examination after each course. These courses are mandatory in the diploma of Musc. Phys. Education |
|
Finland |
Basic Physiotherapy education varies in different Universities of Applied Sciences to some extent. For those working in the public health care system then special / additional training is required. Look above for how to obtain it |
|
Germany |
No. This is however more and more part of the OMT courses and separate courses are now being offered to those who have OMT or the so called pre-OMT level (manual therapy certificate) |
|
Greece |
It is considered an advanced level of training. This training is part of the manual therapy educational programs |
|
Hong Kong |
Yes our undergraduate students received training for physical diagnosis and screening for serious pathology i.e. Red flags, Yellow flags; for spinal cord involvement, cancer, fractures, VBI etc. This is further strengthened in our postgraduate training in Master of Manipulative Physiotherapy, for the subject Physical Diagnosis of Neuro-musculoskeletal Disorders; we have special lectures from consultant radiologists and advanced clinical reasoning training for screening of serious pathology |
|
Ireland |
In hospital situations, many orthopaedic clinics have a physio performing triage assessments; to qualify for these posts, physios generally have a Masters degree in the area before they will be considered for such positions. Some will access further training, usually in the UK under the extended scope practice modules but this is less formal. In private practice there are no such requirements |
|
Italy |
It depends on the university, but in general it is considered an advanced level of training. The advanced training could be the University Master in Manual Therapy (OMT), or some courses in continuing professional education |
|
Japan |
- No sufficient education on primary care assessment is given in the basic education of physical therapy. |
|
Netherlands |
In the 4 years full time basic educational program to become a physical therapist all students are trained extensively in screening serious pathology (red flags). Only the above mentioned obliged course for PT’s was implemented when direct access became available, but nowadays all registered PT’s have the required knowledge |
|
New Zealand |
Yes |
|
Norway |
Additional training is included in the Clinical Masters program at the University of Bergen . This is one of the sections those with foreign education must take before qualifying for direct access in Norway |
|
South Africa |
I would assume that most undergrads receive training in primary care assessment. As the OMPTG in South Africa, our OMT course strongly emphasizes this aspect |
|
Spain |
It is received in an advanced level and usually through specialization courses or a university master |
|
Sweden |
Some undergraduate training and also during CPD |
|
Switzerland |
No |
|
USA |
Accreditation standards require that physical therapists professional (entry) level education includes training in primary care assessment for screening for serious pathology and disease |
|
United Kingdom |
This is covered in undergraduate training |
5. Can physical therapists in your country make referrals to other specialists, or for other specialty services, such as diagnostic imaging?
|
Australia |
Technically physiotherapists can refer for all of these services, however the government will not allow for this to be claimed under Medicare, so patients would have to pay a lot extra. Diagnostic Imaging: There is limited availability of referral for X-Ray under Medicare (spine, hips), but not other areas. No others diagnostic tests are recognised. Medical Specialists: Not recognised under Medicare |
|
Austria |
No |
|
Belgium |
No |
|
Canada |
At this time physical therapists in Canada can not make referrals for diagnostic studies or specialists |
|
Denmark |
No, we can ask the general practitioner to refer the patient. Ultrasound scanning is the only imaging possibility physiotherapists can have access to, if they have the equipment. |
|
Finland |
Physiotherapists can make no referrals to other specialists or services in Finland |
|
Germany |
No |
|
Greece |
The physical therapists can only refer the patient back to the doctor that sent them for therapy (or another specialist) and have an oral communication in order to discuss the problem |
|
Hong Kong |
Not for diagnostic imaging. In private setting, will refer patients to other specialists if the condition indicates, however if patients are paying by their insurance plan, they might require a referral from a doctor to see a specialist |
|
Ireland |
In private practice physios can refer to other specialists who also practice privately. To access services in public hospitals, patients have to be referred back to their GP before onward referral can be facilitated. If a patient is within the public health system, they can be referred to a consultant within the hospital. Physios can refer for imaging privately, but it will not be covered by the patient’s health insurance. Patients must be referred back to their GP / specialist to have imaging covered by their health insurance |
|
Italy |
No, in Italy physiotherapists cannot make referrals to other specialists or prescribe medication: only the physician can, but we can advise the physician about it |
|
Japan |
In Japan, it is mandatory to given physical therapy under the instruction of a medical doctor. However, physical therapists are allowed to recommend and request other specialty services as a medical team member with reference to observation from the physical therapy viewpoint |
|
Netherlands |
No direct referral for imaging or other tests nor to specialists can be made. Only general physicians are allowed to do so |
|
New Zealand |
Yes |
|
Norway |
Yes, we can make referrals for radiological imaging, including MIR scans. We are also able to refer patients directly to Medical specialists, or to our other physiotherapy colleagues. We can give patients up to 12 weeks of paid sick leave |
|
South Africa |
Yes – theoretically (legally) we can, and many pts do, but the insurers often query our referrals. Referral is usually no problem at all, except for financial issues |
|
Spain |
Not in an official way |
|
Sweden |
Not in general but yes, in some cases and in some positions |
|
Switzerland |
No |
|
USA |
Yes though this varies from state to state. Furthermore, the insurance reimbursement of the specialty or imaging service may require additional authorization from the patient’s primary care physician or pre approval from the insurance carrier |
|
United Kingdom |
Clinical specialists and extended scope practitioners who have had the appropriate training can refer to specialists and request diagnostics |