Evaluating the Effect of Basic Insurance Inclusion on Physiotherapy Use: The INSPIRE Study (Insurance and Physiotherapy Research Evaluation)
Summary
ABSTRACT
Background: To promote substitution of care, the Dutch basic health insurance (BHI)
package has expanded in recent years to include physiotherapy for conditions such as
knee/hip osteoarthritis (KHOA), intermittent claudication (IC), and chronic obstructive
pulmonary disease (COPD). These additions aim to improve access to evidence-based
conservative care. However, it remains unclear how they have affected physiotherapy
utilisation in practice.
Aim: This study examines trends in physiotherapy use for KHOA, IC, COPD, and urinary
incontinence (UI) between 2015 and 2023. The primary aim is to assess the impact of
BHI inclusion on utilisation patterns; the secondary aim is to evaluate changes in the
number of consultations per treatment episode.
Methods: We conducted a retrospective cohort study using data from the Nivel Primary
Care Database (Nivel-PCD), covering over 1.4 million patients from 626 physiotherapy
practices in 2023 alone. Annual physiotherapy episodes per diagnosis group were
analysed using multilevel Poisson regression models, with adjustment for practice-level
clustering. Predicted yearly values were visualised to assess trends before and after
inclusion in the BHI.
Results: The inclusion of physiotherapy in the BHI was associated with distinct utilisation
patterns across diagnostic groups. Following coverage in 2017, IC treatment episodes
increased, before stabilising at a higher level than before inclusion. KHOA showed a
gradual decline in annual treatment episodes post-inclusion, while COPD annual
treatment episodes dropped by nearly 50% after 2019. Across all groups, the number of
consultations per treatment episode decreased over time.
Conclusion and key findings:
BHI coverage influences physiotherapy utilisation, but effects vary by condition. While
access increased for some groups, other conditions showed declining use, potentially due
to financial or administrative effects, or evolving guidelines. These findings highlight the
need for policies that address both utilisation and equitable access to care.
Keywords:
Physiotherapy, Basic Health Insurance, Utilization Trends, Chronic Conditions, Health
Policy, Multilevel Modelling, Nivel Primary Care Database