Who is the one who can decide about the appropriate amount of therapy?

Beside the other stations, there is a station in a rehabilitation center where people are direct payers. Often this people come from abroad

, because they heard about a lot about positive progress of patients which have already been there. They pay a lot of money to make some progress and they often have a lot of expectations in the doctors and therapists. Because they pay a lot of money, they also want more therapy sessions than the patients which aren’t direct payers. As physical therapist in such a rehabilitation center with direct payers, it is not always easy to support their claims. Often these patients are in a chronic stage of their illness, where the rehabilitation potential is not as high as in patients which are in the acute phase. Sometimes direct payers get 2 sessions per day, when indirect payer get one therapy session or only 2 per week, considering the lack of therapists in such a center. For the therapists the question raises: Who is the one who can decide about the appropriate amount of therapy? What is fair an what is unfair?


4 Replies to “Who is the one who can decide about the appropriate amount of therapy?”

  1. Hi there. In South Africa our situation sounds like it might be similar, although different in one important aspect. We have two parallel health systems; one which is private (patients pay the healthcare professional directly) and one which is public (where the payment to the healthcare professional comes from the government). This sounds like it might be similar to your direct / indirect system.

    However, where it is different is that patients and therapists don’t move between systems. In other words, if I’m working as a therapist in a private hospital, then ALL of my patients are direct payers, and so there is an equality among them i.e. I treat them all the same. In the public system it is the same, so all patients who are paid for by the government receive the same level of care.

    But this means that we have massive inequality between the two systems. If you have enough money to pay for private physiotherapy then you get many more treatment sessions than someone who is in the public health system.


  2. Thank you very much for your post. Is there any physical therapist who can tell me how it is working in a public or in a private hospital? Do you find it unfair, that private patients get more treatment sessions than public patients? Would you prefer working in a public or in a private hospital?


  3. Hi there.
    As I am a final year physiotherapy student I have only worked in public hospitals. What I have found working in the public setting is that there is a large amount of patients to be seen in comparison with only few physiotherapists at a hospital. This varies from hospital to hospital but influence the amount of treatment a patient receive. In the public setting patients usually only receive one physiotherapy session a day. Some hospitals rely on students to help with the workload. At times when there is no students to help treat patients they will prioritize and treat some patients only every second day. For example a patient who is on bedrest will only receive physiotherapy every second or third day as they are able to do the bed exercises without the assistance of a physiotherapist. Patients who are ready to be discharged but still need to mobilise will be a priority for the physiotherapists.

    I think a physiotherapist should decide the amount of therapy a patient need as they know the patient and their condition. I think the amount of therapy should depend on the patient’s condition and their motivation. If a patient is able to do exercises on their own they might only need one session a day in comparison with a patient who is dependent on a physiotherapist.

    The turnover of patients in public setting is sometimes very fast as they need space for new patients which might be different in a private setting. Therefore there is a big difference between rehabilitation in the two settings. Unfortunately most patients cannot afford private services and is dependent on public hospitals.


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