Current BCSOT Position Statement

BCSOT Position Statement on BCSOT's Role in a Changing Health Care System Also available as a PDF

Adopted by BCSOT Board of Directors, January 28, 2002

I. The Issue

The change in government in British Columbia in 2001 signalled a change in the way health services would be organized and delivered. The Liberal Government has undertaken a core review and numerous other reviews of programs and services. They have indicated that they will look to the private sector to be more involved in health care delivery but they have not been specific about the type or extent of private sector activity. The British Columbia Society of Occupational Therapists (BCSOT) expects that changes will be announced and implemented over time and will affect all aspects of health services delivery, including acute and community care as well as public and private insured services.

The health system will change and almost all those who analyse the current organization and delivery of health services in Canada agree that change is essential. The debate in British Columbia centres around issues of access, cost-effectiveness and who will pay for which services. Change offers an opportunity to present occupational therapy services as key to revitalised and more efficient health services.

II. Background

Occupational therapy makes a positive contribution to the quality of health care for British Columbians. Supporting people with injuries or disabilities to maximize their abilities to function in their work, home and leisure environments will be increasingly important as health care decision makers seek to maximize the effectiveness of health care spending. Occupational therapy is well-placed to make a significant contribution to more effective health services.

Two factors, among many, limit our ability to provide optimal occupational therapy services to British Columbians. First, BCSOT believes there are not enough occupational therapists in BC in either the public or private sectors to meet the current demand for services. Second, clients' access to care is limited by inadequate funding for services in both sectors. These gaps in the continuum of care concern all of us regardless of where we work; 67% of BCSOT members work in the public sector and 33% in the private sector. Currently, about 70% of health services are provided by the public sector, while the remaining 30% are provided by the private sector.

Over the past two years, BCSOT has lobbied steadily for adequate funding and increased spaces in the University of British Columbia School of Rehabilitation Sciences (the School). To support our concern about the shortage of occupational therapists in BC, we funded the "Physical Therapists and Occupational Therapists Workforce Project" in co-operation with the Physiotherapy Association of BC, the College of Occupational Therapists of BC, the College of Physical Therapists of BC, the Health Sciences Association, and the Health Human Resources Unit of University of British Columbia Centre for Health Services and Policy Research.

Similarly, in the past two years, BCSOT participated in Health Human Resource Planning activities at the provincial level and within the Vancouver/Richmond Health Board, the largest health authority in BC. BCSOT was a member of the insurance lobby sub-committee of the Professional Alliance of Canada (composed of all provincial occupational therapy associations and the Canadian Association of Occupational Therapists) which sought ways to jointly promote our profession in the insurance sector.

III. BCSOT's Point of View

BCSOT's mission is to promote the profession and support our members to achieve excellence in practice. We speak for the profession as a whole and we must balance the interests of members in the public and private sectors, different professional interest areas, and geographic location when we approach public issues. We can never go wrong when we put our clients' interests first. They will be best served by broad access to occupational therapy services in the public sector and the private sector and the scarcity of occupational therapy in both sectors leaves lots of space for improvement.

As BCSOT assesses proposed changes, we must ask what impact proposed changes will have on clients. We must ask if changes will improve the continuum of care and what clinical or other evidence exists that indicates that the changes will result in improved services to clients. We must ask for evidence that demonstrates that changing modes of delivery will increase service levels, lead to better outcomes or improve co-ordination with complementary services provided in either the public and private sectors. Finally, we must ask how multidisciplinary care will be protected or enhanced as change occurs. BCSOT members must raise these questions with local decision-makers and at the provincial level.

The ultimate goal of health care restructuring must be better health and better health care for British Columbians. BCSOT will continue to advocate for increased access to our services in the public sector and in the private sector.

BCSOT will be proactive and speak out when changes implemented in either sector reduce or restrict access to necessary occupational therapy services. BCSOT will not take a specific position in the philosophical debate about the appropriate mix of public and private health services in British Columbia, but will instead assess and comment on the impact of change on our clients and our profession.

Changes in public health care coverage may also have an impact on services covered by third party payers. We must assess the impact of ongoing changes to these services according to whether our clients will be positively or negatively affected. We must evaluate whether specific changes enhance or limit the kind or amount of services our members currently provide under contract to third party payers.

Occupational therapists must challenge health care decision-makers and administrators to improve access to occupational therapy services, to improve the health sector's ability to attract and retain high quality practitioners, and to give priority to improving clients' health. These goals can be achieved through more appropriate financial and human resource allocation.

Occupational therapists are enablers, resources to clients who seek to regain, maintain or maximize function. We can play the same role as enablers or change agents in the health system changes by supporting health care decision-makers, administrators and colleagues from all professions to seek change to improve client outcomes, and by enabling decision-makers to seek the best solutions to problems by focusing on what's best for clients.

IV. Taking Positive Action

A. Provincially

BCSOT will promote a broader range of services and an improved continuum of care in both the public and private sectors, building on members' work to promote the profession in their own communities and with their local health authorities.

BCSOT will seek every opportunity to participate in health planning processes to actively promote the essential services occupational therapy provides in all health care sectors, including acute, residential, community, home care and mental health services.

BCSOT will advocate for our profession to major employers and their unions to promote increased coverage for occupational therapy services in extended health plans.

BCSOT will work with the Canadian Society of Occupational Therapists (CAOT) and other organizations on common issues.

BCSOT will continue to suggest or provide materials to members to promote occupational therapy at local events. BCSOT will also provide organizational support to develop special interest groups and professional development activities to support members in their quest for excellence and to raise our profession's profile.

B. Locally

BCSOT members will encourage local employers and unions to add or improve occupational therapy coverage in extended health plans. Members will actively promote their services to ICBC adjusters, other insurance companies and third party payers to build their knowledge of our profession.

BCSOT members will support the maintenance of local services which offer broad access to occupational therapy. Outpatient services provided by acute care or community care facilities are critical for clients who do not have private insurance or do not qualify for other publicly funded programs.

BCSOT will continue to encourage its members' involvement in the ongoing debates in their communities about the orientation and delivery of health services to the people of BC.