Safe Falling?

Airbag
I’m sure that, if this device had been invented during my childhood, I would have been required to wear it. 

A Japanese firm, Prop, is developing an airbag to be used to protect those who fall.  The product is designed for a specific type of fall (elderly with epilepsy) and in proposed to detect an acceleration to the ground which releases an airbag to protect the head and the pelvis.

This type of product is also being used by some motorcycle racers.  I can imagine some embarrassing moments when someone reaches down to pick up their keys a little too quickly!

This link to a news story has a video of the product in action…seems they still have some development to take care of…that last fall must have hurt!!

September 26, 2008 | Filed Under Health Policy

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The Vortex of Bad Healthcare in a Bad Economy

Where Have I Been?

First, my sincere regrets to loyal NPA Think Tank readers who have had to endure an inappropriate delay between blog posts.  Posting is like falling down a hill.  Once you start, it is hard to stop, but once you stop, it is hard to start yourself falling again.  Does that make sense?  I have been swamped with a multitude of tasks all designed to stretch my brain.  I hope it works!  And, I hope I can post more regularly as I am digging out from under this pile of real life, work, and limited time.

VortexThe Vortex

As our country slides down the slippery economic slope, it seems our discussion about healthcare costs and the cost-benefit of direct access physical therapy services becomes more and more pertinent.

I direct you to two studies discussed in this NYT article which connect the state of the economy to the burden of rising health costs.

"The study estimates that 57 million Americans live in families
struggling with medical bills, and 43 million of those have insurance
coverage."

That’s a lot of struggling in a population who is purported to be protected from such events. 

Some in the physical therapy industry are predicting a widespread collapse of the health sector.  From the private practice owner’s vantage point, I can certainly see why they feel this way.  As a specialty service, patients are faced with high co-pays, reimbursement from insurance companies is always putting on the squeeze, and yet patients are continually sent for unnecessary primary care visits for their musculoskeletal pain. 

In light of the government bailout of the ecomomic sector, it begins to appear more plausible that we could end up with a similar situation in healthcare.

In the meanwhile, we may all consider alternative remedies to staying in good health.

ERIC

Photo courtesy of agrinberg

September 24, 2008 | Filed Under Health Policy

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Direct Access: The Netherlands

ResearchBlogging.org

We have established that one of the main barriers to direct access is the issue of third party reimbursement for physical therapy delivered via direct access.  It is difficult to judge the true nature of the benefit or demand of direct access services when they are not being fairly offered (assuming a professional should be paid for delivering services consistent with their practice act is fair!).  Well, a handy situation presented itself in the Netherlands in 2006 and researchers took advantage of it.

The Netherlands decided to implement direct access services in 2006 as part of a larger health care reform which focused on improving the role and ability of patients to choose the appropriate health providers.  Most Dutch insurers reimburse for direct access services.  In addition, patient data was entered into a national database, enabling researchers to examine patient outcomes, demographics, and care patterns during the fist year of direct access implementation. 

Thenetherlands
Several interesting findings came to the surface.  By December of 2006, 32% of patients were seen via direct access, following a steadily increasing trend.  Low back pain of non-specific nature and neck pain were the most common reason for self-referral to a physical therapist.  The patients utilizing direct access seemed to be younger, more educated, and have an onset of problems of less than one month.  Interestingly, the overall number of patients seen by physical therapist did not increase, indicating that fears of over-utilization might be unfounded.

But, what matters most is outcomes, and the data supports improved outcomes in this study as well.  On average, patients being seen by direct access recieved fewer visits and were more likely to be discharged because their goals were achieved than those patients referred by a physician to physical therapy.

What’s really interesting about this study is that it’s like a little market research product bundled into the form of a scholarly paper.  It identifies a target audience, indicates demand, and provides defense of the product’s ability to create a benefit to the healthcare community.  Still, 32% is still a low-ish level of utilization and it would be nice to see how these numbers change over the next few years as patients got more familiar with direct access. 

There might be some really strong evidence to explore concerning the fact that early access to physical therapist for musculoskeletal conditions results in much improved outcomes and a strong cost : benefit ratio.  When that evidence becomes clear is when insurers here in the US will have to take a closer look at their restrictive reimbursement policies!

C. J Leemrijse, I. C. Swinkels, C. Veenhof (2008). Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy Physical Therapy DOI: 10.2522/ptj.20070308

September 1, 2008 | Filed Under Health Policy

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