Changes in health care financing have been having an impact in recent years on. The old fee-for-service delivery system has largely been replaced by new managed care initiatives. Many hospitals and rehabilitation centers are trying to find ways to reduce costs while still trying to maintain quality.

With the introduction of managed care, research has shown that rehabilitation services have declined dramatically. Shorter hospital stays usually translate into less rehabilitation. Where it was once common practice to keep a patient in the hospital for as long as necessary to achieve what health care professionals considered adequate recovery, the incentive in health care today is cost reduction by truncating or eliminating services. Patients no longer have the luxury of leaving the hospital when they are close to resuming a normal daily routine. Today, they are told that they must continue their recovery in another setting, often without the ancillary services that are needed to achieve good progress.

One of the major reasons for this transformation in health care is the perception among members of the business community that it is much too expensive. As corporations began downsizing in the 1980s and early 1990s, searching for ways to reduce overhead became a national obsession. Health care became a topic of great discussion and debate, and managed care, or managed competition as some people would call it, became the code words for reducing costs.

Many health care professionals, including physical therapists, have known for years that what is needed is not a larger-based hospital system, but rather a health promotion/disease prevention agenda that strikes at the core of the problem. Unfortunately, under the traditional system of health care in the United States, most of the financial resources are spent on diagnosing and treating disease, which leaves little or no remaining funds for health promotion. Only after all is said and done with the nondisabled community, do people with disabilities get any attention. Fortunately, this is slowly starting to change, and funding agencies have begun to support health promotion initiatives for people with disabilities.