Models of rehabilitation service delivery need to move to a chronic disease management model that incorporates outcomes that are meaningful to clients, and not the assumed needs or outcomes as defined by rehabilitation professionals.

In early 2005, Canada's most populous province (Ontario) partially delisted publicly funded community-based physical therapy services by restricting the eligibility criteria within designated clinics. The aim of this research was to assess the consequences of this policy decision using a prospective cohort design. In this study, we followed clients before and after delisting in order to assess change in access and self-reported health status. The results indicated that 81 of 113 (71.7%) participants who required physical therapy services continued to receive them after delisting because they remained eligible, were privately insured and/or were able to pay out-of-pocket. Twenty (17.7%) required services but did not receive them because they were uninsured or were not able to pay privately. The remaining participants were discharged at follow-up. Controlling for gender, age, employment and condition, clients who maintained access were 10 times more likely to report very good or excellent health status compared to those who did not receive services (odds ratio: 10.72; 95% confidence interval: 2.20-52.25). Given the association between poor self-reported health status and morbidity and mortality, future research needs to examine the long-term impact to determine the extent to which delisting may be associated with increased utilization of hospitals and family physicians.