Publicly funded physio assessments fell 85% in Winnipeg after services consolidated in 2017: study

The number of publicly funded physiotherapy assessments in Winnipeg has plummeted in the years since all outpatient services were consolidated into a single facility, a new study says.

Researchers at the University of Manitoba say in the 23 months before the consolidation in late 2017, there were a total of 18,261 initial outpatient assessments, compared to 6,715 assessments over the 61 months following.

That means the average number of assessments each month went from 794 in the two years before consolidation, to an average of 110 monthly in the five years following, according to results from the study released this week — a drop of more than 85 per cent.

The study’s authors warn that many patients who used to have public coverage may be falling through the cracks.

“Seeing a physiotherapist isn’t cheap in the private sector,” said Joanne Parsons, an associate professor at the university’s department of physical therapy and the study’s primary author.

“Given the limitations on access to publicly funded physio now and the barriers to private care, we suspect that there’s a large segment of the population that could be benefiting from physio care but is not able to access it.”

The report has been peer-reviewed and approved for publishing in the journal Physiotherapy Canada. Researchers looked at a database of all publicly funded musculoskeletal physiotherapy appointments in Winnipeg between Jan. 1, 2016, and Dec. 31, 2022.

A woman
Joanne Parsons, an associate professor at the university’s department of physical therapy and the study’s primary author, says new patient eligibility criteria introduced in 2017 left out several chronic conditions. (Submitted by Joanne Parsons)

“At the end of 2017, there were some significant budget cuts to health care,” Parsons said, after the Winnipeg Regional Health Authority shuttered outpatient physiotherapy services in seven hospitals, with the city’s Health Sciences Centre becoming the only institution offering those publicly funded services.

Those changes came amidst sweeping health-care reforms brought in under the former Progressive Conservative government, in an effort to cut costs.

Funding for physiotherapy staff was cut by two-thirds, and new patient eligibility criteria left out several chronic conditions, according to the U of M report.

“Common things like tennis elbow, neck pain, ankle sprains, rotator cuff, tendinitis … are not covered anymore,” Parsons said.

Patients with surgical knee conditions, the type most commonly seen pre-consolidation, fell from 13.2 per cent to only 2.8 per cent of the total sample, the study says.

The province reinstituted coverage for patients recovering from hip and knee replacement surgery in 2023 through private physiotherapy clinics. Parsons said that may have helped fill some gaps, but still left out several previously covered diagnoses.

She said previous research found those accessing private physiotherapists in Winnipeg don’t align with the city’s broader demographics. Compared to the city’s general population, those accessing private physio are more likely to have higher incomes and be well-educated, and are less likely to identify as Indigenous or a visible minority.

Parsons said an initial assessment at a private physiotherapist can run up to $120, which can be “fairly pricey” for anyone seeking treatment.

Low-income Manitobans ‘left to live in pain’: association

The Manitoba Physiotherapy Association says the results show people without third-party insurance or a good income can’t get the care they need.

“Certain groups who don’t have access to care that would otherwise improve their life, they’re left to live in pain,” said president Derek Purvis.

“Surgical outcomes are shown to be greatly better if you get physiotherapy after surgery.… Those post-op patients are a big group that are missing out.”

Cars drive down a road past a building complex and under a glass-enclosed pedestrian bridge that says "HSC Winnipeg."
The Winnipeg Regional Health Authority shuttered outpatient physiotherapy services in seven hospitals in 2017, with the city’s Health Sciences Centre becoming the only institution offering such services. (CBC/Radio-Canada)

Wait times for services fell from a median of 15 days to a week after consolidation as there were fewer patients, the report says. But treatment duration has increased, and the number of appointments per patient has also dropped, it says.

Purvis said that indicates people have less access to their therapist, which may lead to a worse quality of care.

“You need to follow up with your therapist,” he said. “Not being able to access your therapist … leaves a lot of the programs home-based, and that’s often not enough.”

Parsons said most other provinces have some sort of access to physiotherapy services based on income, and that she recommends Manitoba to create such a program.

The study also calls for better data on patients’ rehabilitation, so there is a more accurate picture of treatment outcomes.