Canada

Original Editor - Allen Kuhnell.

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

In Canada, physical therapists are primary care providers. While patients may access physical therapists directly, physical therapy consultation may be initiated by physicians for hospitalized patients or outpatients. In some areas, physiotherapists are part of a primary care team. These teams are composed of doctors, nurses, physiotherapists, chiropractors, occupational therapists, midwives, dieticians, pharmacists, and mental health/addictions professionals. In collaboration with the Canadian Ministry of Health, Primary Care Teams (also known as Family Health Teams) serve to improve patient access, while customizing the team makeup depending on the local community served. "While professional practice is guided by each provider’s regulated scope of practice, it is recognized that the working relationship among the members of the team will also take into account the expertise, preferences and skill set of individual providers. No two teams will function exactly alike. Each, over time, will develop its own character, working relationships and culture".

Therapist Preparation

Degree/Credentialing

Canadian PT students earn a Master of Science in Physiotherapy (MScPT) over two years, including approximately 30 weeks of clinical education at a university that is accredited by the Accreditation Council for Canadian Physiotherapy Academic Programs (ACCPAP).

The Canadian health care system also utilizes Physiotherapist Assistants, who are trained at an accredited career college to support the physiotherapist. The Physiotherapist Assistant curriculum is composed of three academic semesters, plus a sixteen week practicum.

Specialization

Common Canadian specialty practice include areas such as: Acupuncture, Animal Rehabilitation, Cardiorespiratory, Neuroscience, Oncology, paediatrics, Seniors Health, Women's Health. Those who plan to serve in an academic or research capacity may pursue a PhD in Rehabilitation Science or Applied Health Science.

Professional Associations

The Canadian Physiotherapy Association (CPA) is the national professional association. The CPA is composed of 11 provincial branches and 14 territorial councils. Members of the Canadian Physiotherapy Association may belong to specialty divisions such as acupuncture, cardiorespiratory, neurosciences, oncology, orthopedics, paediatrics, seniors health divisions.

Information about the Patient Community

Physiotherapists evaluate and treat Canadian individuals across the life span, either as general practitioners, or according to physiotherapist specialties detailed above.
Canada's national health indicators mimic that of other industrialized countries, with respect to common morbidities such as heart and cerebrovascular disease, pulmonary disease, cancer and diabetes." In Canada, as in other developed countries, health statistics have long shown that when men and women of the same age are compared, women have a higher prevalence of chronic disease and use more medical services, but men have higher mortality rates. This apparent paradox has been a major area of theory, investigation, and speculation for many years". As of 2006, Malignant neoplasms was the most common cause of death in Canada (29.7% of all deaths), followed by heart disease (21.9%) and cerebrovascular diseases (6.1%).

Social/Cultural Influences

Canada's governmental structure is a constitutional monarchy, developed under the influences of both French and British empires. Canadian citizens are subject to three branches of democratic government: the executive branch (Queen, Prime Minister), the constitutional parliament (Senate and House of Commons), and the judiciary (court system) branch.
With respect to cultural diversity, the Canadian government officially adopted a multiculturalism policy in 1971 which details three tenets. First, this policy ensures the "value and dignity of all Canadians, regardless of their racial or ethnic origins, their language or their religious affiliations." Second, it affirms the rights of Aboriginal peoples. Third, the policy recognizes two official languages in Canada: French and English.
The vast majority of world ethnicities are represented in Canada, with such ethnic foods, recreational activities, formal and informal associations available to Canadian citizens. Since 1994, Canada has been ranked as one of the top ten countries to live, with citizens benefit from ready access to education, high life expectancy, and low crime rates. Further, Canadians enjoy a very high standard of living, with approximately 70 percent of Canadians owning their own homes.

Canadian family arrangements are diverse, including one parent, two parent, same sex couples (with and without children), common law couples (with and without children), couples with step children or with no children. Canadian families frequently include multiple ethnicities, and contribute to a variety of culturally influenced family dynamics. Dimensions of family dynamics include family interaction and cohesion, moral-religious emphases, intergenerational authority, empathy and family affect, all of which shape the management of household chores, lifestyle, and individual/collective health status.

Delivery of Care

A major criticism of the Canadian health care system has been the perception of extended wait times for access to physicians, diagnostic testing, and intervention. In 2004, the Canadian government made a commitment to improve patient access to healthcare, due to the aging Canadian population and due to the increasing prevalence of certain chronic conditions in Canada. Primary Care teams (as detailed above) serve to improve patient access and reduce patient wait times, while helping patients improve their "health habits" and better manage their own medical conditions.While life threatening situations are handled immediately, routine medical issues are admitted on a first come, first served basis. Since 2005, more than 170 Primary Care Teams have been formed to help alleviate the patient wait times, while improving the quality of service.

Type of Health System

Canada's national health care system, also known as Medicare, provides for reasonable access for all citizens to hospital and physician services. Most services are provided by private entities, who are regulated and reimbursed by the government. The Ministry of Health does not participate in direct patient care, nor does it collect information about individual patient health. Canadian citizens are enrolled in Medicare through the provincial Canadian Ministry of Health, and everyone receives the same level of care.

Payment System

In general, the Canadian Medicare system is funded through income taxes and through a fixed monthly premium (imposed only in some provinces, depending on patient income/need). There are no deductibles, and copayment requirements are rare. While private insurance serves a minimal role in overall health care funding, it is primarily in the form of supplemental insurance for benefits such as a private (versus a semi-private) hospital room, cosmetic or elective surgeries.
Like American health insurance, Canadian supplemental health insurance plans can be categorized generally into idemnity plans and managed care plans. Idemnity plans are essentially "fee for service" plans, usually with a deductible. Managed care plans are offered in Preferred Provider Organization (PPO) and Point of Service (POS) forms. Supplemental health plans typically cover 40-80% of (elective) health care costs.

Resources

WCPT Country profile for Canada