Abstract

Introduction. In 2018, outpatient physiotherapy financed by the National Health Fund (pl. Narodowy Fundusz Zdrowia, NFZ) was provided to 2.6 million patients, i.e. approx. 6.8% of Poland’s population with 128 million services and expenditures amounting to PLN 937 million. The unmet demand for physiotherapy services expressed in terms of waiting times, given the pressure of the ongoing demographic changes, is becoming an increasingly serious challenge for the public healthcare system. International experience suggests that changing the organisation and functioning of physiotherapy could improve its efficiency.

Aim of the study. The study aims to outline the prospects for optimal physiotherapy care provision (organisational and financial framework) within the public funds at the disposal of the National Health Fund (NFZ).

Materials and methods. The sources of data for the analyses were: the database of NFZ services, demographic data and projections of Statistics Poland (pl. Główny Urzad Statystyczny, GUS), literature on the subject and reports concerning organisational solutions. Demographic projections for the country until 2030 (GUS) were used for estimating the demand for outpatient physiotherapy services

Results. Individuals aged 60 and older account for more than half of patients in outpatient physiotherapy (OP). In the perspective of the next decade, the proportion of patients aged ≥ 60 will increase by another 11%. The presented concept of Primary Physiotherapy Care (PPC) involves the cooperation of Primary Healthcare (PHC) with outpatient physiotherapy. PPC assumes the shift of the provided treatment from the provision of single treatments or cycles to physiotherapy care and a population-oriented approach.

Conclusions. The direction of physiotherapy care evolution should take into account different perspectives: (1) patient’s perspective: a) tailoring the therapeutic process to the patient’s condition, b) implementing the process in accordance with available scientific evidence and clinical guidelines,

c) patient’s share in the responsibility for his or her health condition; (2) healthcare provider’s perspective: a) orienting towards achieving therapeutic effect (value), instead of orientation towards the provision of treatment, b) increasing the independence of physiotherapists as therapy managers,

c) adapting human resources and premises to increased patient population and to the structure of treatments provided according to the guidelines,

d) using new forms of therapy: education, instruction, learning self-care at home; (3) payer’s perspective: a) departing from a fee-for-service system towards financing the therapy/care instead, b) introducing indicators for adjusting the amounts of financing from public funds depending on measurable therapeutic effects.

Key words:

primary physiotherapy care, outpatient physiotherapy