Project Title: Resetting the Institutional and Structural Balance in Canada's Health System: the Case of Rehabilitation Services in Ontario

Research Team:
Williams, A.P.
Deber, R.
Lum, J.
Rappolt, S.
Verrier, M.
Landry, M.D.

Research Officers:
Ierullo L.
Carfora S.
Salib D.
Lubbad N.

Research Partners:
Insurance Bureau of Canada
Canadian Health and Life Insurance Association (CLHIA)
College of Physiotherapists of Ontario
College of Respiratory Therapists of Ontario
COTA Health
Funded by the SSHRC (Social Sciences and Humanities Research Council)

Driven by major health system restructuring initiatives, technological advances, and changing social values, an increasing proportion of Canadian health care has shifted outside of hospitals and institutions to home and community. This includes rehabilitation services required by individuals who as a result of accident, illness or aging, need to recover or maintain the highest level of functional ability possible.

In the field of rehabilitation, this shift is complicated by the presence of multiple service "streams". While in hospitals, rehabilitation services are covered by Medicare. In home and community, individuals may receive available services through Community Care Access Centres (CCACs); following an auto accident individuals may have some or all of their care paid for by a private commercial insurer; and workers injured on the job may receive services through the WSIB. Depending on which stream they enter, individuals will have different entitlements to care, and they may pay greater or lesser proportions of the costs out-of-pocket.

The ongoing shift from hospital to home and community thus has major implications for:

• Individuals, who may receive different levels of service and bear a greater proportion of the costs depending on which rehabilitation "stream" they enter
• Providers, who are called upon to supply high quality and increasingly complex services in diverse settings on a cost-effective basis
• Decision-makers, who must determine what resources should be directed toward rehabilitation in addition to other priorities such as acute care and long-term care, and
• Employers, who may come under pressure to provide additional benefits to employees

In this study, we focused on Ontario, and:

1. Assessed rehabilitation services available outside of hospitals
2. Documented differences in approaches to funding and delivery in different service streams, in different areas of the province
3. Identified options for making the best use of available resources

Selected Presentations:

• Landry M, Williams AP, Deber RB, Verrier MC, Rapport SG, Lum J. Physical Therapists' Perceptions of Policy Options for the Future of the Canadian Health Care System: Results from the 2003 Survey of Occupational Therapists and Physical Therapists in Ontario. Paper presented to Canadian Physiotherapy Association (CPA) Congress, 2005. Victoria, British Columbia, May 27th, 2005.

• Lum JM, Williams AP, Rappolt S, Landry M, Verrier M, Deber R. Meeting the Challenge of Diversity. Celebrating Diversity in Occupation National Conference, Canadian Association of Occupational Therapists. Vancouver, British Columbia, May 26, 2005.

Selected Publications:

• Williams, A. P., Rappolt, S., Lum, J., Deber, R., Verrier, M., & Landry, M. D. A portrait of occupational therapy in Ontario: Results of a 2003 survey. OT Now, 6(3):3-7, 2004.

• Lum, J., Williams, A. P., Rappolt, S., Landry, M. D., Deber, R., & Verrier, M. Meeting the challenge of diversity: results from the 2003 survey of occupational therapists in Ontario. OT Now, 6(4), 2004.

• Rappolt, S., Williams, A. P., Lum, J., Deber, R., Verrier, M., & Landry, M. Clinical autonomy in occupational therapy practices: results of a 2003 survey. OT Now, 6(6), 2004.