A Responsibility to Put “Health Policy in Perspective”

The month of November always feels unique to me because it challenges the “rules” used to establish priorities among competing responsibilities to family, country, and self. Everything seems to be a priority right now: local, state, and national elections for political office require even more attention than usual to current events; planning for Thanksgiving requires more attention to extended family; and, with only 2 months left in the calendar year, activities become more frenetic to address expected annual personal goals. In the same way, there are (sometimes competing) responsibilities that we as individual professionals and we as a profession cannot—and should not—avoid. One of those responsibilities is health policy.

In 1995, referring to the previous year's failed health care reform efforts and to managed care, my predecessor, Jules Rothstein,¹ wrote: Physical therapists have played too small a role in the revolution that we have seen…. The time has come for us to consider the levels at which we must interact with a health care enterprise that lives in a state of chaos and flux. Our patients cannot go away until we sort out the mess that is our current reimbursement and access schemes. Therefore, it remains socially irresponsible for us not to find the most effective means for dealing with patient problems within the confines of existing reimbursement and organizational structures. We also would be irresponsible if we did not document and prove in a scientific manner how we and our patients are compromised by any system that we feel is inappropriate…. On a second level, we must remain active and participatory in the dialogue relating to change. This means activism within the organizations that employ our services, and activism at all governmental levels.

Since Jules wrote those words, everything and nothing has changed. On the one hand, many of the same issues that legislators and activists debated then persist in today's health insurance reform discussions. On the other hand, the profession of physical therapy has made great strides in engaging with the larger health care arena. Physical therapists are running for and others have already been elected to public office; APTA has become a clear, strong voice to the legislators on Capitol Hill; and physical therapist scientists are engaged in health services research. We are collaborating with other professionals to produce research with robust health care data that includes physical therapy services, such as Shumway-Cook et al,² Peterson et al,³ Landry et al,⁴ Carter and Rizzo,⁵ and Freburger and Holmes.⁶ This type of work was only just beginning in the mid-1990s.

As a result of these strides, physical therapists are no longer merely reacting to policies developed by other groups; in some cases, we are being asked to help establish policy. For instance, a physical therapist chaired an Institute of Medicine committee that identified steps to strengthen evidence for public and private actions to reduce the impact of disabilities on individuals and society in the United States.⁷ In another example, the Canadian Stroke Network has a vision to achieve measurable improvement in prevention, treatment, and rehabilitation for Canadian individuals, families, and society by 2010,⁸ and physical therapists are participating in this effort as members of boards of directors, as scientists, and as clinicians. There are many other examples that demonstrate that our profession is at the table in 2009 in a way that it wasn’t 15 years ago.

Our profession has matured. We now have physical therapist scholars—not just physical therapists with opinions—to assist in translating evidence into health care policy. Physical therapists can influence the “big picture” with more than anecdotal information.

It's time for PTJ to serve as a scholarly venue to share relevant healthy policy issues (and related ethical considerations) and provide commentary about physical therapists’ role in helping to promote, implement, refine—or defy—health policy. This month PTJ launches “Health Policy in Perspective” (page 1117) with articles by Kigin⁹ and Stout.¹⁰ Led by Editorial Board Member Linda Resnik, PT, PhD, OCS, and PTJ's health policy committee (Janet Freburger, PT, PhD; Alan Jette, PT, PhD, FAPTA; Michael Johnson, PT, PhD, OCS; Justin Moore, PT, DPT; Ruth Purtilo, PT, PhD, FAPTA), this quarterly segment should compel each of us to participate in formulating and “living” health policies that will improve quality of care—and quality of life—for patients, consumers, and society as a whole.

• © 2009 American Physical Therapy Association