Bringing equity to health care access
All Australians deserve access to high-quality health care, yet we continue to see entrenched disadvantage persist across Australia. Inequity remains a key issue for those most in need—those without access to prevention, early detection, and quality care. Our reforms focus on removing barriers and delivering efficient and cost-effective physiotherapy care for the people most in need.
Priority populations stand to benefit the most from physiotherapy-led interventions and we call for reforms across six key areas:
- Securing a better future for First Nations Peoples.
- Enabling health access for Rural Australians.
- Securing the NDIS to support Australians with disability.
- Drive multidisciplinary and connected care for older people.
- Enabling health services that improve outcomes and value for veterans.
- Recognising the vital role of physiotherapy in mental health.
First Nations health
Physiotherapy plays an essential role in improving health outcomes for First Nations Peoples. Physiotherapists provide their patients with the skills and strategies to address a range of conditions, and to prevent and manage chronic disease. However, there is low utilisation of physiotherapy among First Nations Peoples. This is underpinned by a lack of understanding of the role of physiotherapy, financial barriers, and limited access to culturally safe services
Actions we are calling for:
- Physiotherapy services to be prioritised in all newly established health clinics to strengthen chronic disease treatment and rehabilitation.
- Investment in allied health assistant roles as part of the government’s new First Nations Health Worker Traineeship Program.
- A funded trial to embed appropriately trained, culturally safe physiotherapists into Aboriginal Community Controlled Health Services.
How this helps
The actions we call for address the key barriers contributing to the low utilisation of physiotherapy amongst First Nations Peoples: the lack of resources in the community, the absence of culturally safe services and access to affordable services.
Focused care for First Nations Peoples, provided by a culturally safe physiotherapy workforce, will contribute to better health outcomes.
Providing pathways and opportunities for more Aboriginal and Torres Strait Islander People to enter the physiotherapy profession will grow a culturally safe workforce and address the resource gaps in the community.
Our asks of governments require a strong and consistent advocacy effort to ensure adequate funding, and accountability, for investments to grow a culturally safe workforce and embed Aboriginal and Torres Strait Islander-led decision-making at every-level within the system.
Rural health
Every community across Australia deserves access to vital health services. However, many rural communities have no access to physiotherapy services, contributing to disparities in health care.
Despite recent reforms, maldistribution remains a key impediment as many communities lack the resources to build capacity. There is strong evidence for integrated care models to advance allied health services, yet successive health budgets have failed to adopt similar primary care models. The minimal investment provided has seen the bulk of the funding go to doctors and nurses. This is despite allied health representing around one quarter of the healthcare workforce.
Actions we are calling for:
The APA actively contributes to advocacy and strategic policy efforts to address the needs of physiotherapists and their patients working in regional, rural and remote Australia. These include:
- Rebated physiotherapy items to reduce out-of-pocket costs to rural patients.
- Rural physiotherapy to be trialed as part of the Urgent Care Clinic rollout.
- Investment in integrated care models and incentivised team-based care arrangements to increase access.
- Expanded capacity for Primary Health Networks (PHNs) to fund physiotherapy solutions to address rural service challenges.
- Restructure the Workforce Incentive Program (WIP) to directly fund physiotherapy practices.
How this helps
Providing equitable access to care continues to be a fundamental challenge for rural physiotherapists working within private and public settings. We are advocating to secure increased incentives for physiotherapy practice as this is vital to assist communities in attracting and/or retaining physiotherapy services. This includes restructuring the poorly targeted WIP for a more targeted direct incentive program for physiotherapy. The current strategy, which directly funds GPs in rural areas to employ physiotherapists, threatens the viability of independent practices already well established in their local community.
We need fully integrated and managed care pathways, outreach programs and shared care arrangements alongside telehealth.
It is necessary to enable the PHNs to advance physiotherapy-led models of care in rural areas. We call for more focus on new and sustainable rural funding models and connected care. Scaling up and replicating these successful models is important and reliant on ongoing access to funds beyond grant rounds.
Relevant information:
- September 2021 Position Statement – The equitable access to physiotherapy services for rural Australians
- APA Resources – Rural and Regional Members
Australians with disability
Physiotherapists are highly trained to manage acute, non-acute, life-long and life-limiting conditions. For a person living with disability, access to appropriate physiotherapy services positively impacts their personal, social and educational success, and their potential to fulfil their goals.
All people living with disability should have access to appropriate high-quality physiotherapy services, when and where they need it. Accessible, person-centred physiotherapy services—tailored to individual needs and available within a variety of settings in the local community—is essential to optimise function and community participation.
Physiotherapists should be appropriately recognised for their unique skills and wide scope of practice.
Actions we are calling for:
It is critical that people with disability have access to the right support when and how they need it. We want to strengthen the capacity for people with disability to access mainstream physiotherapy services and ensure they have choice and control over the care they receive.
- Immediate indexation with the Consumer Price Index of NDIS price limits for physiotherapy supports.
- Strengthen funding for access to physiotherapy supports in primary care for children and adults living with disability.
- Proper and sustainable funding of the National Disability Insurance Agency (NDIA) so it can deliver on its mission.
The APA has two free online training, which were funded under the Jobs and Market Fund administered by the Department of Social Services. The courses are designed to upskill physiotherapists to increase their confidence in working with people with a disability.
- Build Your Confidence in Disability Management (5 CPD hours)
- Paediatric disability module (4 CPD hours)
How this helps
The promotion of physiotherapists’ skills and knowledge to consumers, the government and the NDIA will increase understanding of the role physiotherapy plays in supporting people with disability. Greater awareness will result in:
- improved choice and control participants have in seeking physiotherapy services, with more physiotherapists offering NDIA services;
- appropriate remuneration and recognition for physiotherapists providing disability services; and
- increased recognition of the physiotherapy scope of practice by the NDIA.
Relevant information:
- October 2022 Industry Joint Statement – Business integrity and legal requirements in the Assistive Technology sector
- June 2022 APA Position Statement – Unregulated Allied Health Assistants
- February 2022 APA Submission – Current Scheme Implementation and Forecasting for the National Disability Insurance Scheme (NDIS)
- October 2021 APA Submission – Current Scheme Implementation and Forecasting for the National Disability Insurance Scheme (NDIS)
Older People
Older People must have improved access to needs-based and person-centred physiotherapy to manage complex comorbities and maintain their quality of life. Physiotherapy is critical in preventing falls, maintaining mobility, and managing complex health issues including pain, continence, and the behavioural and psychological symptoms of dementia.
Our policy is to drive multidisciplinary, connected care closer to home and to ensure the availability of services is proportionate to the size of a growing population. By strengthening the breadth and availability of community services, we could move care out of the hospital and into the community.
People living in residential aged care deserve to choose and receive care from highly qualified professionals who help them maintain their physical and cognitive function, manage pain, prevent falls and lead full lives. The Government has not fully accepted or delivered on the recommendations of the Royal Commission into Aged Care Quality and Safety, while the new funding approach, the Australian National Aged Care Classification, falls short of what is required to ensure that aged care residents receive more than basic care.
Actions we are calling for:
- Take immediate action to address the consequences of recent policy reforms on a rapidly diminishing physiotherapy workforce in residential aged care.
- Comprehensive clinical assessment and targeted funding for physiotherapy across settings to prolong independence and manage the physical and cognitive symptoms of chronic disease.
- Fund an ongoing and nationally scaled up Allied Health Group Therapy Program to prevent falls in aged care residents directly and indirectly affected by COVID infection and control measures.
- Develop a new pathway to activate multidisciplinary rapid response teams to support older Australians in the community with emergency help.
How this helps
The importance of improving access to critical services was highlighted by the Royal Commission.
Preventable injuries to older people costs the health system $3.9 billion annually, and the intervention of physiotherapy-led programs will reduce this burden on the health system. In falls prevention, we have proven strategies to improve quality of life, physical function and falls efficacy, with research showing that physiotherapy-led exercise programs can help reduce falls by 55 per cent.
Relevant information:
- Economic Value of Physiotherapy – NOUS Report
- Falls prevention in Australian Residential Aged Care – Sunbeam trial
2023
2022
Veterans
The Department of Veterans’ Affairs (DVA) supports the complex and substantial health needs of veterans. Physiotherapists provide expert high-quality care to veterans through therapy and clinical exercise rehabilitation. This relationship is vital and has been shown to have positive mental, emotional and social benefits, with physiotherapy services now extending to more than one million consultations annually.
The role of physiotherapy in a veteran’s health journey is essential, but there remain barriers to providing this essential care. The APA is working closely with the DVA on new models of targeted and high-value health services that improve outcomes and value for veterans.
Actions we are calling for:
We want a one-off fee increase for physiotherapists providing services to DVA cardholders. In the past, fee increases have neglected physiotherapists who are not being supported to service veterans in the same way as other allied health professions. Incompatibility between funding and high-quality physiotherapy services is detrimental to veterans’ care.
The current low remuneration for physiotherapists means that these experts in veterans’ care are providing services that affect the viability of their practices.
- A pricing framework that encourages earlier intervention and drives value-based health care through new physio-led models of care.
- The price disparity to be addressed to ensure that physiotherapists can continue to provide essential services to veterans.
- Investment in expanding multidisciplinary mental health teams that offer diverse skills and expertise for both Australian Defence Force (ADF) and veteran populations.
How this helps
Many ADF patients and veterans face challenges with complex health needs. Physiotherapy treatment assists veterans by reducing pain, increasing productivity (return to work), enabling longer life, and avoiding and/or delaying the need for costly disability care.
The funding and type of health services available to veterans are determinants of health for this population. Fee increases for physiotherapists will enable veterans to access physiotherapy services in the same way as other allied health services and will strengthen the veterans’ care pathway. And importantly, fee increases will reflect the high-aptitude, evidence-based care provided by Physiotherapists to ensure practice viability and the ongoing, sustainable provision of the best care.
Relevant information:
- March 2022 APA Submission – Royal Commission into Defense and Veteran Suicide
Mental Health
We support best practices in managing physical pain that contributes to mental health conditions. Best practice involves coordinated, quality care by multidisciplinary, teams to support patients across the whole continuum of care. Physiotherapists are qualified and trained to work with people who have mental illness across all health settings, including hospitals, aged care facilities, disability services and private practice. However, Australia’s mental health system limits this care by not properly investing and promoting team-based care.
Actions we are calling for:
- Physiotherapists recognised and included as valued participants of multidisciplinary mental health care.
- Physiotherapists to be employed in mental health services, recognising that holistic health care involves physical and mental health diagnosis, treatment, and management.
- Investment in education across the mental health sector to raise understanding of the important role of physiotherapy in recognising, assessing, and treating many physical illnesses and painful conditions.
- Public awareness campaigns on the positive impact improving physical health can have on mental health.
- Recognition of chronic pain as a condition with access to Medicare subsidised treatments.
- Primary Health Netwroks are resourced to have the organisational capacity to support greater collaboration between primary health care providers in managing mental illness and pain.
How this helps
According to Pain Australia, major depression is the most common mental health condition associated with chronic pain, with 30 to 40 per cent of people with a diagnosed mental health condition also presenting for treatment for chronic pain.
High-quality mental health care requires a team of healthcare professionals working together to address the multiple factors affecting an individual’s mental health, which can include managing pain, comfort and physical capacity. We know that by enhancing physical health, we also promote mental wellbeing.
Relevant information:
- APA Statement – Formalising the role of physiotherapy in mental health care