Table 1 The organization of physical therapy in The Netherlands

In the Dutch health care system, physical therapists are only accessible after referral by a physician and over 90% of patients attending a physical therapist have been directly referred by their GP. The remaining 10% are referred by a medical specialist. People in the Netherlands have either public or private health insurance, depending on their level of income. Public insurance cover for physical therapy is nationally regulated and in 2002 and 2003 this meant that people with public insurance (66% of the population) and low back pain were covered for 9 treatment sessions per episode per year. People with public insurance were able to obtain additional private insurance that covered them for more than 9 treatment sessions. Private insurance cover (the other third of the population) for physical therapy was not regulated at national level. Every physical therapy session lasts about 25 minutes and physical therapists are paid per session, irrespective of the type of diagnosis and intervention. In the Netherlands, nearly all therapists working in primary care are organised in private practices.

The Dutch situation will change in 2006; the differentiation between public and private health care insurances will disappear and physical therapy will be accessible without a referral.