Welcome to Worldwide Physical Therapy Practice: a focus on Primary Care Physical Therapy
This is a project created by and for the students in the School of Physical Therapy at the University of St. Augustine in St. Augustine Florida. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
- 1 Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
- 2 Therapist Preparation
- 3 Professional Associations
- 4 Information about the Patient Community
- 5 Social/Cultural Influences
- 6 Delivery of Care
- 7 Type of Health System
- 8 Payment System
- 9 References
Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
- In the Netherlands prior to 2005, primary care general practicing physicians were the gatekeepers of citizens healthcare services regulating access to specialists consultation. At that time, it was a publicly funded healthcare system an option of private health care insurance depending on an individual or family's income level.  Until 2005, citizens of the Netherlands had to access physical therapy through their primary care physician through referral.  Data in 2005 showed approximately 90% of physical therapy patients were referred from their general practicioner and approximately 10% from a medical specialist.
- Beginning in 2006, differentiation of physical therapy care coverage (public versus private insurance) has disappeared and Dutch citizens have free direct access to physical therapists. Physical therapy care is provided through individually purchased healthcare plans offered.
- Physiotherapists in the Netherlands recieve a diploma of either a Bachelors of Arts in Physiotherapy or Bachelor of Science of Health in Physiotherapy requiring four (4) years of post-secondary education. All programs researched by the editor had focus in both theoretical and practical realms. A Master's degree program in Physiotherapy/Exercisetherapy for People with Chronic Disease are available through Hanze University of Applied Sciences Groningen. The Master's degree is designed to further one's competencies in the following areas: serving as a specialist care provider, innovator/ professional developer, content-driven leader and advisor. 
- Universities offering degrees in Physiotherapy in the Netherlands include:
Hogeschool van Amsterdam Studierrichting Fysiotherapie:
Hogeschool West-Brabant Opleiding Fysiotherapie
Hogeschool Eindhoven Opleiding Fysiotherapie
Hanzehogeschool Hogeschool van Groningen (HVG)
Hogeschool Enschede Academie Fysiotherapie
Hogeschool Limburg Opleiding Fysiotherapie
Leidse Hogeschool Studierichting Fysiotherapie
Hogeschool Nijmegen Opleiding Fysiotherapie
Hogeschool Rotterdam Opleiding Fysiotherapie
Hogeschool van Utrecht Opleiding Fysiotherapie
Fontys Eindhoven- University of Applied Sciences (English-based program)
International Academie "Thim van der Laan"
- Several options exist for specialized practice in the Netherlands. Manual therapy has a long tradition among Dutch physiotherapists. In the mid to late 20th century, manual therapy in the Netherlands was practiced in an experience-based paradigm with influences of well known manual therapists such as Maitland, Grieve, Paris, Cyriax, Freddy Kaltenborn and many others.  Recent shifts in manual physiotherapy include evidence-based shift to include an Evidence Based Guideline Forum advocating clinical practice methodology utilization.  Standardization of manual therapy technique terminology has been of interest internationally, including the Netherlands, but without clear success. 
- Some facilities, such as Musculoskeletal Research Centre in Nijmegen, offer an internationally recognized title of part-time Master Musculoskeletal Physiotherapy (MMPT), granting specialization in manual therapy, orofacial physiotherapy or sports physiotherapy.
- Paediatric physical therapy is also available as a specialization in the Netherlands.
- Theoretical competenicies typically include general experiential competency with movement toward a Master's Degree. Clinical competencies typically include mentorship and guided/supervised experience in a specialty area. The member organization, KNGF, in the Netherlands usually requires a minimum of 2-3 years experience before entry into a specialization Master's programme.  Specialists are registered in the member organization and re-registration is required. Re-registration is due every 5 years and proof of appropriate professional development is evaluated by their member organization board. 
- The Royal Dutch Society for Physiotherapy (KNGF) is the member organization for physical therapists practicing in the Netherlands. Membership is required for practice in this country. It is the only professional organization in the Netherlands and the oldest physiotherapy professional organization in the world, established in 1889. The mission of the KNGF is not only to enable physiotherapists to serve in a curative role but preventive one as well.
- Website for the Royal Dutch Society for Physiotherapy (KNGF) : http://www.fysionet.nl/english.html
- The Royal Dutch Society for Physiotherapy (KNGF) also provides the clinical practice guidelines for a number of dysfunctions including Whiplash Associated Disorder (WAD), low back pain, rheumatoid and osteoarthritis and acute ankle sprains. These clinical practice guidelines are important in terms of fostering international collaboration as well as supporting the physical therapist to make the best clinical decisions available for the patient in their clinic. This link is provided for the page in English: https://www.kngfrichtlijnen.nl/654/KNGF-Guidelines-in-English.htm
- Other professional affliations include: the Dutch Association of Orofacial Physiotherapy (NVOF), the Dutch Association for Sports Physical Therapy (NVSF) and the Dutch Association for Manual Therapy (NVMT).
Information about the Patient Community
- The Netherlands has a population of approximately 16.7 million people with 17,500 physiotherapists practicing to fulfill the need for services in this country. According to Swinkels et al , patient demographical data comparing patients treated in US, Israeli and Dutch clinics showed that 38% of patients had acute symptoms(<1 month) compared to 18.4% in the US and 14.3 in Israel.  In all 3 databases reviewed, the lumbar spine was the area most frequently treated at 21.9% in the Netherlands and 30.6% in the USA. The neck, knee and shoulder were treated frequently in all 3 countries upon statistical review of the databases. 
- According to World Health Organization Data, chronic diseases were responsible for 88% of all deaths, communicable/maternal/perinatal/nutritional deficiencies accounted for 8% and injuries 4%.  Body mass index data from 2005 shows 62% of men being overweight compared to 55% of overweight body mass index values for women. 
- Dutch family life is somewhat different from their neighboring European counterparts, generally speaking. For example, the notion of family is defined by two separate words: "gezin" which is immediate nuclear family of mother, father and children. Dog or cat pets are cherished and considered part of this "gezin." The second word describing family is "familie" which would be extended family including relations by marriage. The nuclear or "gezin" family has strong ties while the "familie" tends to have more distant and removed ties. When members of the "gezin" marry off, they typically lose ties more quickly with the "familie" than in other European cultures and children are typically raised solely by their biological parents with less involvement by the "familie." It may be hypothesized that an elderly parent's children may have less involvement in medical decisions later in life. Problems and issues are solved by all in the "gezin" household most of the time and potential solutions offered by all members. The Dutch national charachter is said to be liberal and individualistic. Birthdays and diplomas/graduations are celebrated heavily as academic achievement often directly relates to income in one's adult life in the Netherlands.
- Living conditions in the Netherlands are typically described as the nuclear family residing under one roof under which much focus is on development of the children. In a typical Dutch household, both mother and father work though the mother may work part-time to afford sufficient time for rearing the children. The freedom of employment for the mother has underpinnings in the 15th century when the plague dramatically reduced the workforce prompting females to rise to the demand for able workers during this time.
Delivery of Care
Type of Health System
- The Dutch national health care system has experienced many changes since inception of universal health coverage for all citizens in 1941.  This mandated a health insurance plan that was at a reasonable cost to lower and middle income families while higher income groups typically purchased insurance from private insurance companies.  As access to healthcare increased, so did cost and eventually the Dutch government became concerned of the global fiscal ramifications. As Wynand et al  state, this prompted the Healthcare Prices Act which was passed in 1982 allowing government control of physician's fees and total revenue. Eventually, 'rationing' of care was met with public disapproval due to the inefficiency and lack of incentive for providence of quality care. This inspired reorganization of the system with the aim of offering universal healthcare coverage and competition/ incentives for providing quality care while educating the consumer about their choices in care.
- Universal healthcare coverage was attained in the Health Insurance Act of 2006 which requires anyone working or living in the Netherlands to purchase a private healthcare insurance plan.  This plan takes a taxable income-based structure and requires payment of premiums to the private company. However, employers are required to reimburse employees toward the community-rated premium.  Government subsidies are available to nearly two-thirds of Dutch families on a yearly basis.  A government-sponsored website is available so that individuals and families can shop among insurers for the best plan to fit their unique health needs. This website also offers citizens information on performance ratings of hospitals and other ancillary healthcare providers such as physiotherapy clinics based on a number of indicators. 
- Payment for healthcare services, including physiotherapy, is provided by individual private health insurance companies. Individuals choose their own company and plan based on individual healthcare needs. Physiotherapy is a covered benefit in many plans offered by these health insurance companies. The cost of physiotherapy service depends upon consumer choice of plans so cost can vary among individuals.
- Swinkels ICS, Hart DL, Deutscher D, van den Bosch WJH, Dekker J, de Bakker DH, van den Ende CHM. Comparing patient charachteristics and treatment processes in patients receiving physical therapy in the United States, Israel and the Netherlands: Cross sectional analyses of data from three clinical databases. BMC Health Serv Res. 2008 Jul 30; 8: 163.
- Leemrijse CJ, Swenkels ICS, Veenhof C. Direct Access to Physical Therapy in the Netherlands: Results from the First Year in Community-Based Physical Therapy. Physical Therapy Journal. 19 June 2008; 88(8): 936-946.
- Hanze University School of Applied Sciences Groningen[homepage on the internet]. Groningen: School of Healcare Studies. Available from: http://www.hanze.nl/home/International/Schools/School+of+Health+Care+Studies/Programmes/Bachelor+Programmes/Physiotherapy/Welcome.htm
- Oostendorp RAB. Manual Physical Therapy in the Netherlands: Reflecting on the Past and Planning for the Future in an International Perspective. JMMT. 2007; 15(3): 133-141.
- Wynand P, van de Ven M, Schut FT. Universal Health Insurance in the Netherlands: A Model for the United States? Health Aff. May 2008; 27(3): 771-781.
1) Swinkels ICS, Hart DL, Deutscher D, van den Bosch WJH, Dekker J, de Bakker DH, van den Ende CHM. Comparing patient charachteristics and treatment processes in patients receiving physical therapy in the United States, Israel and the Netherlands: Cross sectional analyses of data from three clinical databases. BMC Health Serv Res. 2008 Jul 30; 8: 163.
2) Leemrijse CJ, Swenkels ICS, Veenhof C. Direct Access to Physical Therapy in the Netherlands: Results from the First Year in Community-Based Physical Therapy. Physical Therapy Journal. 19 June 2008; 88(8): 936-946.
3) Hanze University School of Applied Sciences Groningen[homepage on the internet]. Groningen: School of Healcare Studies. Available from: http://www.hanze.nl/home/International/Schools/School+of+Health+Care+Studies/Programmes/Bachelor+Programmes/Physiotherapy/Welcome.htm
4) Wynand P, van de Ven M, Schut FT. Universal Health Insurance in the Netherlands: A Model for the United States? Health Aff. May 2008; 27(3): 771-781.
5) Oostendorp RAB. Manual Physical Therapy in the Netherlands: Reflecting on the Past and Planning for the Future in an International Perspective. JMMT. 2007; 15(3): 133-141.
6) Holten N, Jetzinger R, Bergman B. General Meeting of the European Region of the WCPT: Interim Report on Recommendation on Specialisation for Physical Therapists. May 2006. Available from:http://www.physio-europe.org/download.php?document=202&downloadarea=7
7) WHO. The Impact of Chronic Diseases in the Netherlands: Facing the Facts. Available from:http://www.who.int/chp/chronic_disease_report/media/impact/netherlands.pdf