Steve Barnes, Le-Ann Dolan, Bob Gardner, Marianne Stevens, & Elisse Zack. (2012). Equitable Access to Rehabilitation: Realizing potential, Promising Practices, and Policy Directions. The Wellesley Institute. Retrieved from http://www.wellesleyinstitute.com/wp-content/uploads/2012/06/Equitable-Access-to-Rehabilitation-Discussion-Paper1.pdf
This discussion paper is the outcome of a think tank session the Canadian Working Group on HIV and Rehabilitation hosted in March 2011. It outlines issues of access to rehabilitation services for people living with complex chronic and episodic conditions1, promotes discussion on appropriate and timely services, and identifies opportunities for policy-makers and clinicians to consider issues related to chronic conditions and episodic disabilities and to take action to address these issues.
- Rehabilitation services can provide the support that people with injuries, chronic conditions, and episodic disabilities need in order to maintain, improve or regain their health and carry out daily activities like maintain employment, participate with friends and family, and engage with their community.
- Rehabilitation provides immediate support when health conditions have become serious, but also prevents deterioration into more debilitating crises.
- Increasing rates of chronic disease, an aging population, managing the complexity of episodic disabilities, increasing cost pressures and other key trends and pressures across Canada will make rehabilitation services even more important.
- Rehabilitation is often an overlooked, under-recognized, undervalued, and underutilized component of the continuum of health care programs and services.
- Gaps in the availability of rehabilitation services can lead to inequitable access.
- A lack of awareness of rehabilitation amongst health providers and patients may lead to underutilization of essential services.
- Public and private sector funding for rehabilitation and other health services has been diminishing through delisting, alterations to funding formulas and reductions in benefits, making rehabilitation much less available.
- The cost of services can be a barrier for people who do not have adequate employment benefits or cannot afford to pay privately and don’t meet the criteria for modest publically-funded supports.
- The stigma and discrimination that surrounds some chronic and episodic conditions can prevent people from accessing the services they require owing to a lack of training amongst health professionals and reluctance amongst patients to participate in self-care.
- These barriers to rehabilitation may lead to increased costs associated with acute and/or long-term care and result in further increased costs as disabling conditions deteriorate without access to necessary preventative or therapeutic rehabilitation. Therefore in comparison to acute and/or long-term care, rehabilitation may be seen as a cost effective measure.
- System fragmentation and lack of coordination underlie difficulties in navigation and access, but also negatively affect the quality of care for patients.
- We need to see rehabilitation as a key component of a high-performing health system. Rehabilitation has the potential to:
- Deliver enormous benefits to consumers by providing evidence-based high-standard care that will help them get and stay healthier;
- Improve population-level health outcomes by ensuring equitable access to high-quality responsive rehabilitation services and support; and
- Benefit the health system by helping to manage chronic and episodic diseases, reduce avoidable hospital admissions and acute treatment, and keep people healthier, longer.
- To realize this potential, a comprehensive rehabilitation system is needed to:
- Ensure equitable access to rehabilitation services by targeting, identifying, and eliminating barriers faced by under-served regions and vulnerable populations.
- Deliver flexible person-centred care that recognizes the complex and changing needs of people with chronic conditions and episodic disabilities.
- Fit within an effective continuum of care that is responsive to patient need, including providing health services outside of medical settings.
- Be better coordinated to ensure seamless care for patients. Align with health sector priorities, such as, primary care reform, strategies for chronic disease prevention and management, quality improvement, and creating a more effective balance between institutional and community-based care.