Shifting sands: assessing the balance between public, private not-for-profit and private for-profit physical therapy delivery in Ontario, Canada.
BACKGROUND AND PURPOSE: The vast majority of health services within Canada's single payer universal health care system are publicly funded. Despite the highly political and controversial emphasis placed on public funding, the structure of delivery within this health care system does not require public ownership. In this research, we developed a conceptual framework for analysing the public and private mix of physical therapy (PT) delivery in the province of Ontario. We then applied this framework to examine the shifts in employment structure of physical therapists (PTs) in Ontario. METHODS: A two-phased health policy case study methodology was used. In the first phase, we reviewed publicly available documents and conducted a series of 30 key informant interviews in order to develop our framework. In the second phase, we applied the framework and performed secondary analysis of the provincial PT registration database to assess change in practice setting between 1996 and 2002. RESULTS: We identified nine models of delivery that fall into three categories of ownership structure: (a) public; (b) private not-for-profit; and (c) private for-profit. During the six-year period between 1996 and 2002, the relative proportion of PTs employed in the not-for-profit sector decreased (from 59.6% to 54.8%) whereas the share in the for-profit sector grew (from 40.4% to 45.2%). CONCLUSIONS: The shifting balance in the structure of delivery may be transforming how PT services are provided in the province. Private for-profit providers appear to be increasing their market share; however, the outcomes relative to this shift has yet to be fully explored. Further policy and health services research is warranted to more fully understand the consequences of this shift on variables such as professional autonomy, access, cost and quality of services across Canada, but also within similar and dissimilar international jurisdictions.
Landry, MD; Williams, AP; Verrier, MC; Holyoke, P; Zakus, D; Deber, RB
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