The Maltese insurances’ perspective on direct access measures within physiotherapy private health insurances

Abstract

The World Confederation for Physical Therapy (2013) describes self-referral as the client’s ability to access physiotherapy without a referral note. Studies show that this depends on direct access which is in turn dependent on numerous factors, which led to the main research question; “What is the Maltese health insurances’ perspective on direct access measures to private physiotherapy services?” The objectives of this study endeavour to establish the perspective of the health insurance companies on the physiotherapy profession, and to analyse direct access to physiotherapy as conditioned by current structures and procedures implemented for reimbursement by insurance companies. The whole population (n=6) of private health insurance companies was involved in the exercise, and a 100% response rate was achieved. A self-designed, structured interview with open-ended questions was developed and used. The main themes that emerged from the findings, through thematic analysis (Braun and Clarke, 2006) were: Terms in Health Insurances, Professionalism and Health Insurance Policy Requirements. The findings presented the various restrictions that exist for reimbursement of physiotherapy services through private health insurance companies in Malta, namely; the required referral note and other documents, the basic rates for one physiotherapy session, the yearly packages and the administrative and settlement measures that reimbursement entails. Additionally, there were some eligible expenses that are not even reimbursed. Such is the situation that service users’ are not being met or satisfied. Moreover, it was established that physiotherapy is perceived as complementary/ alternative or as an out-patient benefit that could possibly explain the prohibition of cross-referrals. Furthermore, promotion of physiotherapy benefits is non-existent. To conclude, more research studies should be undertaken on a national, European and international level with regard to the effect of reimbursement methods imposed by private health insurance companies on direct access to physiotherapy services.