Thanks Physiobase for the discussion. Most points have now been made, given the tit for tat exchange. forum participants will now have a good understanding of the though processes involved with Associations and members. If others feel the MAPA issue requires further input, I look forward to the opinions expressed.

Two days ago I had a discussion with a highly placed WorkCover representative in Victoria. She informed me that the Authority would not reimburse the cost of nedles used for trigger point dry needling, as acupuncturists do not charge separately for these items, and it would be a contradiction if physiotherapists were reimbursed. She also made the surprising admission that she thought that private patients were not charged for such extras, therefore WorkCover should not have to pay either.

Two points: Acupuncturists only undertake acupuncture, and their service provision charges include their needles. Physiotherapists undertake a wide variety of techniques, and with extra training this can include trigger point dry needling. If physiotherapists restrict some techniques for private patients only, as Insurers will not fund the cost of consumerables, then there will be two levels of treatment, with compensible patients being the poor cousins. This in turn will affect treatment outcomes, necessitating more treatments for a given outcome, or poorer outcomes for compensible clients. Both examples will cost Insurers more money in the longer term, if they are to carry out ethical care. Therapists cannot therefore be responsible for the poorer outcomes.

Secondly, private patients do pay for consumerable items, plus they pay a higher rate for treatment than the compensible bodies do for treatment of their patients. It is unfortunate that the Insurers seem so insulated and out of touch with reality, and that this dissonance is encapsulated within Insurer policy.

The WorkCover lady also commented that people on Insurance generally took longer to return to work and required more treatment than private patients. This is a spurious argument, and compares oranges with lemons.
If Insurers pay less for services than private patients, Physiotherapy businesses can respond by using new graduates or less experienced staff - causing delays in return to work and increased frequency of treatment (see Damian Mitschs posting).

Patients without compensible insurance cannot always afford to self fund, and may receive less than optimal treatment frequency, and return to work earlier than they should due to economic considerations.Such patients may then carry an injury for much longer, with the injury becoming chronic, and affecting them much longer than those receiving may adequate treatment due to nsurance.The Insurers keep records of treatment frequency and treatment costs for their clients, however they do not have access to self funded patients, and therefore cannot do comparisons - and should never base policy upon assumption.

A person injured at work through no fault of their own expects that they should be rehabilitated at no cost to themselves, as it was a failure of the employer to provide a safe work environment, with adequate duties. Disability caused by work is the reason for the Insurance schemes being set up. A person injuring themselves outside of work takes the rehabilitation responsibility and cost upon themselves if it was their own fault.
Managed care organisations cannot have it both ways. If they want top professional care for their clients, they have to pay. If not, they must take responsibility for poorer outcomes due to interference via low remuneration and therapist treatment decisions being over ridden.
More comments welcome.
MrPhysio