BUSINESS MODELS IN PHYSIOTHERAPY: A FRAMEWORK TO INTERPRET THE PROFESSION’S TRAJECTORIES IN ITALY

Autori

Cordani Claudio [Department of Biomedical, Surgical and Dental Sciences – University of Milan and IRCCS Galeazzi Sant’Ambrogio Hospital, Milan, Italy]

Pollet Joel [Department of Clinical and Experimental Sciences – University of Brescia and IRCCS Fondazione Don Carlo Gnocchi, Brescia, Italy]

Baseotto Chiara [Ospedale di Vittorio Veneto – ULSS 2 Marca Trevigiana, Vittorio Veneto (TV), Italy]

Altavilla Sabrina [Health Professions Directorate – ASL CN2, Verduno (CN), Italy]

Picardi Salvatore [AORN-Ospedali dei Colli, Naples, Italy]

Baroni Andrea [Department of Neuroscience and Rehabilitation – Ferrara University Hospital, Ferrara, Italy]

Caselli Serena [Azienda Ospedaliero-Universitaria di Modena, Modena, Italy]

Brindisino Fabrizio [Department of Medicine and Health Science “Vincenzo Tiberio” – University of Molise, Campobasso, Italy]; Contino Domenico [Azienda Sanitaria Provinciale di Enna, Enna, Italy]

Del Vecchio Mario, Rappini Valeria, Giacomelli Giorgio [Government, Health and Not for Profit (GHNP) – SDA Bocconi School of Management, Milan, Italy]

Staltari Maria Grazia, Simonelli Marta [Central Committee of the Orders of Physiotherapists National Federation, Rome, Italy]

Background and aims

Physiotherapy in Italy is delivered through a wide range of organizational models across both public and private sectors. In the National Health Service, services are provided by local health authorities and hospitals. In contrast, private practices vary significantly, from solo practitioners to complex multidisciplinary clinics. A major challenge is the lack of a shared, structured understanding of these models among institutional stakeholders, which hinders strategic planning and policy development. This study aims to create a comprehensive framework to identify, classify, and map the main physiotherapy business models. The objective is to support the national federation and regional professional boards in developing evidence-based strategies for professional growth, service integration, and market positioning.

Methods

An inductive qualitative approach was used to identify key variables and distinguish patterns within and across practice types. A Delphi process was conducted over six iterative rounds with a panel of 10 experts and two external facilitators. The panel reached consensus on the most relevant factors shaping the value proposition of physiotherapy settings, resulting in a refined list of classification variables. Four business model types emerged: 1) traditional physiotherapy practices, 2) physiotherapists’ business associations, 3) rehabilitation-focused polyclinics, and 4) multispecialty outpatient centers. Sixteen case studies were then purposefully selected to validate the models, ensuring geographic representation. The cases were analyzed based on team structure, service scope, patient access, remuneration, funding sources, and degree of multidisciplinary integration. These variables are informing a national data collection initiative involving local Order Presidents, data from the “Sistema Tessera Sanitaria,” and a large-scale survey of registered professionals.

Results

At this stage, no quantitative data are available. The results of the preliminary phases consist of a shared descriptive framework of physiotherapy business models. This has enabled the definition of critical variables to be included in the upcoming nationwide survey. These variables include organizational structure, care delivery models, integration with other professionals, patient pathways, and sustainability mechanisms.

Conclusion

This ongoing study represents the first attempt to conceptualize and comprehensively categorize business models in Italian physiotherapy. The emerging framework will guide a broad mapping process and generate insights into current trends, potential risks, and strategic opportunities for the profession. The involvement of the local boards and the National Federation of the Orders of Physiotherapists is anticipated to ensure representativeness and institutional relevance of the forthcoming initiatives.

REFERENCES

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