A Brief South African Birds Eye View from Singapore of the Private Sector Globally

(information gathered from The IPPTA registered countries namely; Australia, Belgium, Canada, Denmark, Eire, Finland, France Germany, Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, Switzerland, United Kingdom and USA).

South Africa’s official population estimated in July 2014 was 54,002,000 people. Number of physiotherapists registered at the HPCSA 6,686. Resulting in 8,077 people per physiotherapist. Approximately 55,7% of registered physiotherapists in South Africa are in private practice.

Physiotherapy/Physical therapy is a protected title in almost all countries except Eire.

In South Africa the HPCSA draws up the scope of practice for physiotherapists with the continuous review and consultation of the SASP, unlike Australia, Denmark, Netherlands, Norway and Canada where the state is responsible to define the scope of practice.

In Belgium and France they do not have direct access to their patients and thus are not first line practitioners. Diagnosis by a physiotherapist is not permitted in Belgium, Germany, the Netherlands or Sweden. In Belgium they can’t even offer preventative advice and/or services. Countries such as Switzerland, Belgium, Denmark, Finland, France, Germany, the Netherlands and Norway may not refer to specialists.

There are approximately 1500 private physiotherapy practices in South Africa, which in turn results in approximately 36,001 people per practice.

Globally referral to physiotherapist comes from four sources namely;

-         Self/patient 28,9%
-         Doctor 65,6%
-         Insurance 8,3%
-         Work 3,15%

11 countries charge an hourly rate, 8 charge per service and 7 countries charge modality based. Many are a combination of two or even three methods of fee charging.

Sources of funding/reimbursement in South Africa compared to all the other IPPTA registered countries is as follows; Government – South Africa 43%, others 42%, Insurance/medical aids – South Africa 44%, others 32%, Patient – South Africa 12%, others 24%, other forms – South Africa 0%, others 7%.

These are just a few essential comments of our work environments. As many of them reveal working as a private practitioner in South Africa is not all bad.

If you benchmark the private physiotherapy practice in South Africa to the rest of the IPPTA member countries then South Africa is actually doing very well and are ahead of many developing countries.

Samantha Dunbar

Chairperson of PhysioFocus


FIND A PHYSIO MOBILE APP – Proudly bought to you by PhysioFocus

The “Find a Physio” mobile app is in the final phases of development. After implementation of some additional suggestions, the final product has just been approved.

This “Find a Physio” app will replace the printed directory supplied every 2nd year.

Timeframe for completion: This should be available to all PhysioFocus members by August/September 2015.

Benefits of this mobile app are

  • Information kept up to date
  • User friendly
  • Less expensive than the printed directory

At IPPTA this was the “hot” topic.

We will wait to launch South Africa before going international.



Samantha Dunbar (Chair PhysioFocus)

Samantha Dunbar and Wilna-mari van Staden (representing PhysioFocus), Wilma Erasmus as part of the Executive committee of IPPTA, attended the IPPTA meeting that was held in Singapore from 2-4 May 2015.   This meeting was a great success.

Fourteen of the seventeen member countries attended the general meeting. The Member Organisation Representatives (MOR’s) are getting to know each other, allowing networks to be established and business relationships to flourish. The MOR’s have continuous interaction throughout the year with monthly reports been written by various countries.

Each country had to present  “what’s hot or not in their country”.

Globally physiotherapists are struggling with many topics related to the South African climate. 

The United Kingdom has problems with the "middle man” buying and selling physiotherapy services and undercutting the treating physiotherapist.  They are exploring ways to establish a business arm and/or physiotherapy network running parallel to their organisation, but apart from the NGO status quo and legal framework prohibits it.  

Globally standards of care in the private sector are a problem and the need for treating principles and guidelines that are evidence based is globally needed. 

Canada is embarking on standards of care and facility project and we have offered assists, using our accreditation program. 

Germany is fighting against an open free market as they see this change in the health care industry to have seve negative effects on quality of care.

Interesting points on each country to consider:


  • Normal working hours 9h00 to 18h00. Thereafter double time. 56% increase in numeration between 2012-2016
  • Workforce retention down at the of age 30
  • Almost 6000 new graduates
  • Support and education on physiotherapy on how to treat private patient vs government subsidised patient
  • JOB SHOW annually       


  • No direct access
  • No primary prevention
  • No group sessions
  • No possibility for multidisciplinary health care… Royal Decree 78


  • Public funding
  • Episode of care model for service delivery and reimbursement
  • Shift in hospital funding – quality based procedures
  • Primary care role
  • Quasi-public
  • Block funding models
  • Penalty based pay
  • Greater accountabilities for reporting
  • Reduction in insurance plans – health spending account
  • Paradigm shift -  patient as consumer orientated service

Just to name a few.

A new executive committee was elected:

Wilma Erasmus (Chair ) – South Africa

Denis Kelly (Vice Chair) – New Zealand

Margaret Revie (Secretary) – UK

Tim Nemeth (Treasurer) – Belgium

Marc Chevalier – (Member Organisation Representative)  -  Switzerland

PhysioFocus would like to thank all the members of IPPTA for their detailed presentations, knowledge and guidance.

We are all looking forward to WCPT in 2017, and PhysioFocus would be hosting IPPTA then too.


News from South Africa



PhysioFocus organises a Roadshow to all the major cities in South Africa annually. Johannesburg, Cape Town and Durban have already been visited with Pretoria to follow. The Roadshows takes place on a Saturday (full day) and on a Sunday (morning only). Attendees can attend both or one of the two days.

The aim of these Roadshows are to provide members with information with regards to new developments or changes in

  • ·         the general healthcare environment
  • ·         the legal environment
  • ·         ethics
  • ·         practice management
  • ·         Prescribed Minimum Benefits
  • ·         ICD-10 coding
  • ·         Treatment codes
  • ·         Billing requirements

Click the link below to read the article in full

Physio Focus


Physical Therapy Belgium .....An Update

On Tuesday 20 January, Axxon and the national insurance companies reached an agreement on the content of the one year valid convention. The president of the Convention Committee did his utmost  to make sure a convention, scraggy as it may be, was signed before the governmental deadline; thus insuring a possibility of further negotiations in 2015.

The members of Axxon and the members of the board were asked to vote on the content of the suggested mini-convention. A little more than 60% voted “yes”. Wisdom prevailed and although this signed convention contains nothing more than the 5 agreed upon items, without this there would have been no possibility to negotiate any dossiers this year.

This signed framework gives us the possibility to keep working on much needed change in the Belgian legislation regarding how Belgian PT’s need to organize their work situation.



Physical Therapy in Belgium - The future is now!

White smoke from an unventilated fire soon turns into black smoulder. The current situation of  Belgian physical therapy is not much rosier. In December 2014 after nearly 10 months of negotiations, Axxon the Belgian professional organization, put an end to the current convention. The convention is an agreement, mostly for 1 or 2 years, between the government, the national insurance companies and the physical therapists, where certain ‘rules of engagement’ are stipulated. The situation was no longer tenable.

After months of lobbying the negotiations led us into a dead end, where the demands and expectations of the physical therapists are never to be reconciled with the unwavering attitude of the two largest national insurance companies. No adaptation made or no new negotiated convention is allowed when there is even one measure that will cost the patient as little as € 0. 01! We were kindly invited to finance new and necessary initiatives with a diminution of our fee. Even the new Minister of Social Affairs and Public Health is not in a position to create an opening. The uncertainty on the budget control in March and the rather strict European criteria are paralysing the government. If the perspective would arise on a farsighted vision on a healthy healthcare, in which qualitative physical therapy has its valued place, it is not to be expected before the year 2016. 

The ultimate proposition of the national insurance companies was to prolong the current convention. Axxon decided not to accept this outstretched hand because this offers no perspective and guarantee on needed adaptations in the convention what so ever in the near and distend future.

 At the negotiating table now is – at Axxon’s request – a mini convention for 6 months, maintaining the fees and the reimbursements and maintaining the social statute and the premium for the use of labelled software. In addition Axxon demanded to include 5 more items in the mini convention.

  1. First the signed engagement of the committee to harmonize the reimbursement fees for all the different types of pathology based treatment possibilities. Interlinked with this a guarantee that funds released are reinvested in the physical therapy sector.
  2. Second the authorization that physical therapists can autonomously decide whether a treatment is to be given in the practice or as a home visit. Up to now, it was the medical doctor who made the obliged prescription who decided where the whole treatment sessions had to take place.
  3. Thirdly, the publication of the long overdue report on the mandatory collection of the co-payment.
  4.  Fourthly, the budget neutral reformation of the social statute. This is a premium given yearly to all physical therapists who sign and work under the national convention. The reformation visions a greater benefit for the physical therapists who are self-employed. Finally a reinjection of means recovered from outliers in the sector of physical therapy.

This mini convention is to be considered as a first step towards a long-term future vision negotiated convention, containing substantial improvements for the physical therapist. Meanwhile this mini convention secures our interests and creates time for the technical council and the convention committee to examine, calculate and work and on suggested slopes. This mini convention would be effective from January 1st and expire on June 30th. It has to be signed by all parties before January 16th.

Before signing this mini convention, Axxon is going to ask for the judgement of its members. If the members decide that even this mini convention has not enough leverage, Axxon is not going to sign a collective convention. In this case the government is going to send each individual physical therapist a proposition of a new convention. It will be exactly the same as the previous one. If 60% of all physical therapists (members of the professional organization and non-members) sign this proposition it is legally excepted and binding for all. Meanwhile, until a convention is signed, all fees for physical therapy treatment are free.

As I mentioned last September, the fall and winter promised to be very hot in Belgium and I am sure that with the upcoming negotiations spring will be even hotter. I hope that when we meet in Singapore the situation for the Belgian physical therapists will be a bit stabilized and all the above typed text will be a momentary reflection of a brief unpleasant period in Belgian physical therapy history.


To be continued …

Tim Németh