Clinician's Commentary on Armstrong et al.1

Armstrong et al. 1 have made an important contribution to the literature regarding the physical rehabilitation sector of the health care system with their investigation into how health care resources are allocated in the home care setting in Ontario. Although the small sample size and narrow regional scope make it difficult to generalize the results of this type of study, they may contribute to how home care case managers make decisions, particularly decisions about how health care resources are allocated and services are prioritized across various populations. One of the key premises of the article is that demand for physiotherapy (PT) and occupational therapy (OT) services will increase over the near and far term. That claim can also be found in reports from a wide range of jurisdictions. 2,3 Given that demand for services is considered to be a vital upstream consideration for the allocation of health care, it could be valuable to question the seemingly infallible assumptions that underlie the following claim related to the increasing demand for physical rehabilitative services: People aged 65 years and older currently access PT and OT services at home, and the number of people older than age 65 years is increasing. Therefore, demand for PT and OT services will increase. However, is a growing senior population the only factor that affects demand for a particular service? And, more important, what exactly are people demanding? Do seniors want PT, or do they want to remain healthy? Do they want balance retraining, or do they want to prevent falls? Considering demand for physical rehabilitation services more precisely could be a valuable undertaking to potentially improve our confidence in allocating resources for health care services. Understanding, measuring, and reporting demand for health care present several challenges that do not necessarily exist in other industries. The classical economic definition of demand is usually framed as a consumer's desire and willingness to purchase a good or service. Measuring demand can be relatively straightforward in other industries because increased sales volume equals increased demand for a product. When a manufacturer sees an increase in sales for a particular product, he or she can be fairly confident that demand for the product is increasing. However, understanding what contributes to a con-sumer's desire and willingness to purchase can be challenging. The same use–demand relationship does not exist in the health care sector: Use of the services provided does not necessarily equate …