Abstract:
Probably every rehabilitation professional began his or her involvement in the field with an attempt to do something which clearly appeared to be "a good thing" for a specific client or group of clients. Probably most of us have stayed in the field because of a desire to continue to do "good things" This is to be commended; at one time it was sufficient to enswe our continued employment and the acceptance of our output by government or other funding agencies.
But we cannot afford the level of health care to which we have become accustomed, and as the level of service entitlement is reduced the criteria for approval of any device or service becomes more stringent. Rehabilitation devices, systems and techniques no longer will be approved simply because we recommend them and the clients demand them; because they are "good things".
In North America, on both sides of the 49th parallel, the latest fashion is "Managed Health Care" Stripped of the rhetoric from which consultants are linng their pockets, managed health care simply means that we are losing the right to determine what we shall do with someone else's money. Both government and private sector health care insurance plans are limiting available benefits to a degree considered impossible a few years ago Regretably, preventive and rehabilitation measures seem to be targeted for particularly drastic reduction To ensure that any service or device will survive on the list of remaining entitlements, two requirements must be met. First, it must be proven to be cost effective, in the sense that removing it from the list will increase cost to the funding agency. Second, the evidence of this cost effectiveness must be placed before the funding agency effectively.
But we don't have such evidence. For some time now, "Outcome Studies" have been on the wish lists of health care research funding agencies, but the response from the research community has been unenthusiastic. Now, valid and convincing outcome studies are of aitical importance to all of us who wish to continue to work in rehabilitation.
