There's false economy in this ACC measure

OPINION: There's a very clear risk in ACC's decision to reduce patient subsidies for accident victims who receive physiotherapy - some people with injuries who need treatment will not receive it.

From this week, the Accident Compensation Corporation has reduced the subsidy it pays accident victims by about $15 per visit as part of its moves to reduce its costs. The move is likely to see most physiotherapists introducing part-charges to make up the shortfall.

How much of an additional fee physiotherapists charge will vary according to the costs each practice faces. Some will try to absorb the loss of subsidy. For others, this will not be realistic.

An independent report on ACC costs published in 2007 found that the physiotherapy profession was underfunded by 33 per cent. The additional 30 per cent reduction in subsidy ($15) will add to the financial pressure on patients and will force many more physiotherapists to introduce a part-charge to cover costs.

Physiotherapists run their own businesses and can sympathise with ACC's desire to manage its costs. However, as health professionals we also believe it is important that the real issue - the need for people with injuries to receive treatment - is not lost in a welter of confusing figures thrown around.

Debates about the cost of providing health services are exercises in balancing the need to provide people with reasonable standards of medical care against society's ability to pay for that medical care. As with all healthcare, we need to ensure that in managing health costs we do not create financial barriers that stop a significant proportion of the population receiving the treatment they need in order to be productive members of society.

What concerns the New Zealand Society of Physiotherapists is that reducing physiotherapy subsidies for accident victims is pushing physiotherapy out of reach of many people who need it. Even before the new part-charges take effect there have been worrying signs that people may not be accessing the physiotherapy they need.

Media coverage of ACC's impending changes has been enough to reduce the number of injured people seeing physiotherapists. Some clinics are reporting a significant drop in patients receiving care in the period following the announcement of the subsidy cut but before it took effect. We have had reports of decreases of up to 60 per cent in patients accessing physiotherapy.

Many people may delay seeking treatment. Instead of moving quickly to resolve problems, people will put off treatment until the injury becomes too aggravated to ignore. This will unnecessarily increase the pain and suffering that people will endure and shows the public's confusion about their ability to access treatment under ACC.

At the same time, treating injuries later often means people will require more treatment and will take much longer to get back to work. The overall cost of delayed treatment is therefore likely to be higher than if people seek treatment sooner.

A real risk of the new policy is that the costs of treatment will rise over time while patients have reduced access to the treatment they need.

What is to be done to avoid this lose- lose scenario? We believe there are two areas of activity that need to be looked at.

First, patients need to be encouraged, despite the part-charge, not to delay treatment. Timely treatment is the best way to ensure the fastest and best result. It is also likely to be the cheapest option, because fewer sessions are likely to be required.

The second and harder course of action is to carefully monitor the effects of the changes to ensure that we achieve the correct balance between the need to control costs and provide an effective level of care.

Any analysis needs to go beyond a superficial interpretation of numbers and dig into the realities that sit behind them. For instance, one of the reasons for the move to a partial subsidy was that the ACC saw no change in rehabilitation rates after the fully-funded scheme was introduced in 2004.

Rehabilitation rates are about how quickly people who are off work go back to work and as such are not a good guide to the effectiveness of physiotherapy. That's because approximately 20 per cent of the patients we see are not working because of their injury. That means that for 80 per cent of patients, physiotherapy helps to maintain people in work and play. More research needs to be carried out on this large group before we can draw any firm policy conclusions.

Improved research and analysis will be needed to ensure ACC puts in place a system that genuinely lowers health costs without stopping people who need treatment receiving it. This is vital to ensure that we have a healthy and productive society.

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