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OHIP Covered Physiotherapy: Pros & Cons, Eligibility, and Availability

By: Ryan Davey, PhD  
November 5, 2019
Editors: Ryan Davey, PhD and Lindsay Davey, MScPT, MSc, CDT

Man signing OHIP covered physiotherapy forms.

Like most clinics in Ontario, Toronto Physiotherapy made the decision not to participate in offering OHIP covered physiotherapy.

Even though we don’t offer it, we certainly field a lot of questions about it. Ontarians appear largely unclear about what OHIP funded physiotherapy is, where they can get it, and whether or not they are eligible; and government websites (such as the Ontario.ca webpage) don’t go far enough to explain it.

Critically, even if you are eligible to receive OHIP covered physiotherapy, should you?

OHIP funded physiotherapy takes a different form than what you might experience in many privately funded physiotherapy clinics – do you know what these differences are?

Here I will give you a more thorough overview of OHIP funded physiotherapy than you will find anywhere else.

Feel free to post a question or comment at the end of this article.

Who is eligible for OHIP covered physiotherapy?

This bit is relatively straightforward. To be eligible you must have a doctor or nurse practitioner’s prescription for OHIP covered physiotherapy AND be one of the following:

  1. 65 years old or older.
  2. 19 years old or younger.
  3. Any age if you have recently spent a night in a hospital (as an inpatient) for an injury or condition that could benefit from physiotherapy.
  4. A recipient of either the Ontario Works or the Ontario Disability social assistance programs.

What conditions or injuries qualify for OHIP covered physiotherapy?

In order to receive a prescription for OHIP covered physiotherapy your doctor or nurse practitioner will need to establish:

  1. That you have an injury or condition that results in reduced mobility or inability to function in your daily life.
  2. That your injury or condition would be expected to benefit from physiotherapy treatment.

Can I receive OHIP covered physiotherapy for arthritis or other chronic condition?

If you have a prescription for physiotherapy and meet the above eligibility criteria, then you can receive OHIP funded physiotherapy for chronic conditions, albeit with significant limitations:

OHIP will only cover physiotherapy targeted at resolving an acute episode or worsening of symptoms, and only if this worsening has reduced your mobility or ability to function in your daily life.

OHIP funded physiotherapy is not designed to address the long-term rehabilitation needs or ongoing management of chronic disease. This is an unfortunate consequence of how OHIP physiotherapy is funded – a topic we’ll cover further below.

How does OHIP covered physiotherapy work?

If you are eligible and have a prescription in hand, you are free to find an OHIP funded physiotherapy clinic and book in for treatment. OHIP funded physiotherapy clinics are private businesses that are under contract with the government of Ontario to offer this type of care. These businesses typically also provide private services for non-OHIP patients.

When you arrive at the clinic for your first visit you have now begun your “Episode of Care”. The clinic is required to provide you with as much physiotherapy treatment “as needed” to address your prescription. Sounds great! But as usual, the devil is in the details.

When are patients discharged from care?

Unfortunately, your “Episode of Care” will come to an end once any of the following loose criteria have been met:

  1. Your physiotherapist believes you have achieved the rehabilitation goals set out by you and them.
  2. Your physiotherapist determines that you should be able to achieve your rehabilitation goals on your own without further help from them.
  3. Your physiotherapist determines that you should be able to achieve your rehabilitation goals using another means such as by participating in a community exercise, falls prevention, or other class.
  4. Your physiotherapist determines that you are unlikely to see further improvement from additional physiotherapy.
  5. You decide to stop coming for your own reasons.

Why would an OHIP clinic want to discharge you early? After all, the clinic is being paid to offer OHIP funded service, and has agreed to do so. Regrettably, a few years ago OHIP changed their clinic reimbursement practices. Instead of paying clinics per patient visit, clinics are now paid a small lump-sum amount for each “Episode of Care”, regardless of how many sessions the patient attends; so the clinic gets paid the same amount for treating a patient once as it does for treating a patient ten times. Worse still, the lump-sum amount they are paid per “Episode of Care” falls far below market-rates for physiotherapy (more on this below). The result: OHIP funded clinics have a very strong financial incentive to end your care as quickly as possible, and to provide care as cheaply as possible.

What is included in OHIP funded physiotherapy?

While you are attending the clinic, your physiotherapist will focus exclusively on the injury or condition outlined in your prescription. The clinic is not allowed to charge any additional fees related to the provision of physiotherapy within your “Episode of Care”, this includes any materials, equipment or supplies provided. However, they can recommend and sell you additional unrelated products or services, such as massage therapy.

I’ve already had OHIP funded physiotherapy this year, can I go again for another injury?

The number of “Episodes of Care” per year is not limited. For example, if you have an unrelated injury or condition, still meet the eligibility requirements set out above, and get another prescription for physiotherapy from your doctor or nurse practitioner, you can return for another “Episode of Care” at the same, or any other, OHIP clinic.

What if I stayed overnight in a hospital and have already received physiotherapy there? Can I still qualify to get physiotherapy at an OHIP funded clinic in my community?

Physiotherapy provided in the hospital setting is covered by OHIP and is typically of high-quality. Unfortunately, our hospitals are space and resource challenged, and so it is common to be discharged from the hospital in a state where you still require further physiotherapy care. In this case your discharging doctor or family doctor can offer you a prescription for additional physiotherapy at a private clinic in the community that offers OHIP covered physiotherapy.

What if I have a mobility restriction that necessitates receiving physiotherapy at home?

OHIP funded home-based physiotherapy is organized by Local Health Integration Networks (LHINs). You can find your local LHIN here, or learn more by calling 310-2222.

Pros of OHIP covered physiotherapy

If you are eligible and have a prescription:

  1. It’s unlimited!* Get as much care as you need to address your prescribed need.
  2. It’s free!* You don’t have to pay any fees to access this care.

*Sort of.

Cons of OHIP covered physiotherapy

1. It’s not exactly unlimited

And this isn’t just because eligibility is restricted. OHIP pays private businesses to offer this care, and the funding these clinics receive to do so is significantly below market rates. Whereas OHIP has negotiated to pay clinics $312 per patient “Episode of Care”, your motor vehicle accident insurance offers clinics more than ten times this much for an episode of care (up to $3500 for a minor injury case). Likewise, the Ontario Physiotherapy Association recommends that physiotherapists charge at least $150 per hour, and many clinics in Ontario charge in excess of this. So to receive unlimited treatment for Ontarians at a cost to the government of only $312?!? What a deal for the province of Ontario!

How can private business afford to provide care at such steeply discounted rates? After all, these private clinics must still pay their employees at market rates and pay their leases and other overhead as well. What’s going on here? It’s simple economics: these clinics are incentivized to provide care as inexpensively as possible and to end care as quickly as possible, and of course they have found ways to do so (more on this below), otherwise they would no longer be in business.

2. It’s not exactly free

Although you shouldn’t be paying anything out of pocket, you also don’t get the same type of physiotherapy as you could get if you paid out-of-pocket or paid using extended health insurance or automobile insurance. For private businesses to provide OHIP covered physiotherapy at such steeply discounted rates, they must reduce the cost of providing care. General cost-saving approaches such as foregoing an attractive looking clinical setting, or not having private treatment rooms will help, but in the end, they must look to their biggest cost-driver: their physiotherapists.

When it comes to human resources, popular cost-saving measures include limiting patient face-time with their physiotherapist by: double or triple booking patients; using support staff to provide care; having patients spend time alone doing exercises, leaving patients alone with a heat pack or other modality; providing care in a group-setting; narrowing the scope of care; and ending care as soon as possible. For example, having a physiotherapist assistant monitor three patients while they do exercises in a gym would constitute ‘physiotherapy’ under OHIP’s guidelines. But it would certainly not pass as physiotherapy in most non-OHIP funded physiotherapy clinics.

As you can see, OHIP covered physiotherapy is not exactly free, because it’s not exactly the type of physiotherapy that you can receive elsewhere. It’s true that you don’t have to pay anything out of pocket, but you are getting a low-cost model of physiotherapy care – and investing your time, effort, and energy to do so. With that said, this form of physiotherapy might be just what you need.

3. Fewer clinic options and longer wait lists

Not surprisingly, most clinics do not offer OHIP funded care. This limits the number of available clinic locations, and in some cases can result in long wait-lists. Clinics are allotted a specific number of “Episodes of Care” each year and are encouraged to spread them out over the year. Once they have used this allotment, OHIP clinics must wait until the next calendar year to get more.

Wait lists are further exacerbated by that fact that OHIP patients can be far less lucrative than non-OHIP patients attending these clinics, and are often unable to go elsewhere, which reduces their priority in the queue.

Should I go to an OHIP physiotherapy clinic?

If like most people you are financially constrained, then of course it’s worth it to give it a try!  It won’t cost you anything other than your time, effort and energy. If you end up feeling that you didn’t receive the right type of care, the most effective care, or enough care, you can always pay privately elsewhere either out of pocket or through private insurance.

Keep in mind that paying privately at a non-OHIP funded physiotherapy clinic doesn’t have to be as expensive as it might first appear.

For example, at our clinic initial assessments are one hour long and are entirely one-on-one with a Registered Physiotherapist for the whole duration. As a result, our “assessments” typically include time for hands-on treatment, education and home exercise prescription. There is also never any obligation to commit to additional visits. Your therapist will work with you to find a frequency of follow-up visits (if any are required) that best suits your physical and financial needs. Learn more about our model of physiotherapy care.

Finally, the more work you put into your rehabilitation, the sooner you will recover. In most cases, committing to your prescribed home exercise program will help speed your recovery and reduce the need for additional in-clinic care.

Physiotherapy also qualifies for the Medical Expense Tax Credit on your personal income tax return.

Where can I find an OHIP funded physiotherapy clinic?

The complete list of clinics that provide OHIP covered physiotherapy services can be found here.

Could my employer cover my costs instead?

Like many Ontarians, you may work for a small or medium-sized business (or own one yourself) that does not currently offer employee health benefits. Try asking for them. Speaking from experience, many small and medium-sized businesses will choose to provide their employees with health benefits if they feel that their employees would truly benefit from them, and would appreciate them as an employment perk.

You might think that small and medium-sized business can neither afford nor be able to mange an employee benefits plan, but there is a popular and accessible alternative to classic group health insurance. Inquire with your employer about setting up a flexible, easy to manage and inexpensive Health Spending Account like we use.

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  1. Deb Deb says:

    Hi Ryan: Really appreciate your posts, as always.  As a lymphedema advocate, I know that the OHIP physiotherapy system for those who qualify is not ideal.  However, I also know from surveys done that there are many Ontario lymphedema people who don’t have enough private insurance or no financial access at all to buy their lymphedema care. I have heard of one ON OHIP PT who uses the 312.00 as best as possible over 2 to 3 visits to give a little bit of hands on MLD/Therapy and as much teaching for self care as possible. Obviously other recommendations would potentially be made based on individual case. But the person on ODSP, OW or >65yrs is getting something when may they would not get anything at all due to their very limited resources.  I get your points, but in really tough lymphedema scenarios, I truly wish we had more OHIP funded opportunities for those who are really without resources and are in a tough place or have had cellulitis flare and need at least some counselling about their condition.   Thanks for reading!  Hoping that the province can band together and teach policy makers how badly we need a model of care for lymphedema that helps those without private insurance or other financial means to control the chronic inflammation and potential for fibrosis.  If you have further comments, would love to hear! Thanks again, Deb

  2. Great comments as always Deb, I agree with you. OHIP does not appear to be set up or funded to support the management of chronic conditions, and this is particularly true for the less common ones including lymphedema. I don’t know what the answer is, but without a significant increase in overall health care funding there is likely no way that the numerous cracks in our system can be filled. Belts can be tightened, and priorities shifted, but in the end it seems like we are always taking from Peter to pay Paul.

  3. marta marta says:

    Hi! I am 76 years old and i have arthritis and a mild stenosis at the lumbar site. It’s according the x rays result. I am attending a OHIP Physiotherapist clinic and I am getting 10 minutes of laser treatment. The psyoterapist was indicating some exercises, and he has said that he does not know when I will be right.

    Crucial pain is coming as soon I got up and I start walking. Now my question is if I’ll go to other physio clinic and pay from my pocket, could I get better. In other words , the treatment could be different and get better sooner?

  4. Hello Marta,

    I am very sorry to hear of your pain stemming from your stenosis/degenerative changes at the lumbar spine. Hands-on manual therapy would be my recommendation for you, in addition to specific exercises designed to re-establish core stability, flexibility, and to help you learn how to rise up to standing without pain. I can tell you that private clinics that have a focus on manual therapy do prioritize providing the most evidence-based treatment possible, manual therapy to get stiff joints gliding better and to decrease the stress on joints and tissues that are being over-loaded. That, along with soft tissue massage to the muscles that are often in spasm/too much tone, is typically also incorporated, and then as I say, a specific home exercise program is always needed in order that the patient feels relief and long-lasting effects as quickly as possible. I can’t speak to the techniques and modalities used at your OHIP clinic but I do think you may very well see a different approach at a private clinic, which may provide more meaningful relief, yes. Best wishes, Lindsay Davey

  5. Catherine Catherine says:

    Hi!
    I qualify for OHIP but I am considering sport physio instead through my benefits so I can get back to my active self after my ORIF tri-mal.
    Can I start with sport physio through benefits and then switch to OHIP once I run out of my benefits?

  6. Hello Catherine,

    Yes, you are allowed to use your health benefits at a non-OHIP clinic and then switch to an OHIP clinic if you need to after your benefits run out.

    Best of luck with your recovery!

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