The Effect of a New Payment System on Physiotherapeutic Management of Patients With Low Back Pain in Primary Care

Objective: To evaluate differences regarding the number of treatment sessions, costs, and outcomes (including relapses) between a regular pay-ment-per-session system and the recently introduced product payment system in The Netherlands.Design: Prospective cohort study.Setting: Dutch physical therapy practices in primary care over a 2-year period.Participants: 16,103 patients with low back pain (LBP).Intervention: The new product payment system is compared with the regular payment-per-session system.Main Outcome Measures: Pain, disability, recovery, number of physical therapy sessions, therapy duration, costs (per episode), and LBP relapse.Results: At baseline, we found greater pain and disability scores associated with an increased risk profile in both payment systems. With regard to the payment systems, we found greater costs (euro283.8 vs euro210.8) and a greater percentage of relapse (4.5% vs 2.8%) for the product payment sys-tem compared with the payment-per-session system. Comparing the 2 payment systems within each risk strata, we found no significant differen-ces, except for a decrease in pain in the medium-risk stratum. Concerning the therapy characteristics, we found that in the payment-per-session group, the therapy took 6 days longer for low-risk patients (median 27 vs 21 days) and 7 days shorter for high-risk patients (median 42 vs 49 days) compared with the product payment group. Moreover, the mean number of sessions in the payment-per-session group was greater for low-risk patients (5.4 vs 4.8 sessions) and lower for high-risk patients (7.7 vs 8.1 sessions) compared with the payment-per-session group. Finally, the costs were significantly greater in all strata of the product payment group compared with the payment-per-session group.Conclusions: The 2 payment systems are largely comparable regarding patient outcomes, therapy duration, and treatment sessions. Both the aver-age cost per patient per LBP episode and the number of relapses in the product payment system are statistically significantly greater than in the payment-per-session system.Archives of Physical Medicine and Rehabilitation 2023;104:738-44 (c) 2023 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)