Rehabilitation services funding and rehabilitation outcomes: Does one affect the other?

In any society, decisions regarding the allocation of economic resources are a reflection of that society's priorities. Nowhere is this truer than in health care systems. However, the health care industry is not a truly open marketplace, in that the consumer or payer does not always know what he is buying. Outcome measurement is one attempt to "level the playing field" and is intended to allow transparency and comparison between health care providers and between different technologies. In rehabilitation, outcome measurement is a particularly difficult task, given the complex interaction among many patient variables and different treatment methodologies. Notwithstanding these difficulties, health care systems are increasingly demanding the implementation of evidence-based medicine (EBM) and outcome measurement (OM) in rehabilitation. Thus, the provision of rehabilitation services is becoming increasingly similar to a consumer purchasing a product about which he demands a right to know, in terms of quality, quantity, and results. As this relationship strengthens, the payment is bound to influence the medical outcome, and vice versa. This review explores the possible bidirectional influences of these two characteristics in rehabilitation. A model is proposed that attempts to optimize this relationship for the benefit of patients and society at large.