In early 2005, Canada's most populous province (Ontario) partially delisted publicly funded community-based physical therapy services by restricting the eligibility criteria within designated clinics. The aim of this research was to assess the consequences of this policy decision using a prospective cohort design. In this study, we followed clients before and after delisting in order to assess change in access and self-reported health status. The results indicated that 81 of 113 (71.7%) participants who required physical therapy services continued to receive them after delisting because they remained eligible, were privately insured and/or were able to pay out-of-pocket. Twenty (17.7%) required services but did not receive them because they were uninsured or were not able to pay privately. The remaining participants were discharged at follow-up. Controlling for gender, age, employment and condition, clients who maintained access were 10 times more likely to report very good or excellent health status compared to those who did not receive services (odds ratio: 10.72; 95% confidence interval: 2.20-52.25). Given the association between poor self-reported health status and morbidity and mortality, future research needs to examine the long-term impact to determine the extent to which delisting may be associated with increased utilization of hospitals and family physicians.
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| Variable | Odds ratio | 95% Confidence interval | |
|---|---|---|---|
| Gender | 0.39 | 0.10-1.65 | |
| Age (years) | |||
| 20-40 | 3.02 | 0.26-35.00 | |
| 41-65 | 1.09 | 0.19-6.20 | |
| Employed full or part time | 1.37 | 0.28-6.74 | |
| Condition | |||
| Back and hip | 0.66 | 0.09-4.87 | |
| Upper extremity | 0.09 | 0.02-3.55 | |
| Lower extremity | 0.22 | 0.04-13.96 | |
| Other | 0.06 | 0.02-1.79 | |
| Self-reported health status before partial delisting | 62.30 | 12.34-314.45 | |
| Access to services after partial delisting | 10.72 | 2.20-52.25 | |
With respect to health outcomes as measured by self-reported health, the results in Table 2 indicate that access to services after delisting was statistically associated with clients reporting good health at follow-up. After controlling for self-reported health before delisting, age, gender, employment status and condition, participants who required services and received them after delisting were more than 10 times as likely to report good health (odds ratio = 10.72; 95% confidence interval = 2.20-52.25) compared to those who required but did not receive services. Other variables such as age, gender, or access to private insurance were not significantly associated with differences in SRH status between groups in this study.
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