A year into Labor’s second term, the reform landscape appears active but those working within it see a system operating under strain. 

As APA General Manager, Policy and Government Relations, I have observed how the immediate post-election energy has shifted into something harder: delivering on proposed plans. 

Implementation, fixing what’s broken and keeping spending in check now drive the reform agenda across every major health portfolio. Within that environment, healthcare reform feels less like a finish line and more like a crossroads. 

A modest but important reform window is opening, most notably through the scope of practice reform process and the work now moving through Medicare advisory bodies, including proposed changes to Chronic Disease Management items and direct referral pathways. 

These processes matter because they show a willingness to tackle structural problems that have been on the radar for years, even if progress remains uneven. 

This is playing out under sustained system pressure. Governments are trying to reform the health system while managing rising demand, workforce shortages and tight budgets, with reform efforts coordinated through bodies such as the Primary Care and Workforce Reviews Taskforce. 

Reform is moving but it’s cautious, incremental and increasingly shaped by cost containment rather than expansion. 

These conditions are already shaping how services are funded, accessed and delivered. Within this context, reform is also constrained by policies that remain strongly GP-centred. 

The scale of investment required to restore universal bulk-billing has created GP-focused, NHS-style reform architecture, limiting scope for physiotherapy and leaving allied health reform on the margins. 

Primary care continues to default to GP-led coordination and referral, reinforcing this orientation. 

While the approach offers familiarity and system control, it slows the pace at which physiotherapists can be integrated into the Medicare Benefits Schedule as independent contributors to care delivery. 

Primary Health Networks sit awkwardly in this picture. 

They are responsible for commissioning multidisciplinary care and control significant funding. 

However, uncertainty about how best to use that funding is limiting both scale and consistency. In practice, commissioning decisions tend to play it safe, leaving national reform ambitions unevenly realised at a local level and reinforcing the same traditional referral pathways rather than enabling new models of care. 

The rollout of Medicare Urgent Care Clinics has faced similar issues. These clinics were designed to relieve pressure on emergency departments, particularly from the high volume of patients with musculoskeletal complaints. 

However, physiotherapy has not been consistently embedded as a formal part of their clinical teams. 

Addressing the musculoskeletal burden that continues to flow through emergency departments will require greater use of first contact physiotherapy but the current Medicare Benefits Schedule referral rules and payment models are constraining this process because they reflect an earlier era of care delivery rather than contemporary practice. 

Against this backdrop, the Scope of Practice Review marks a genuine shift in the reform conversation by questioning whether allied health should be better utilised as well as how and where change might realistically occur. 

This is a meaningful step, particularly for physiotherapy, which is well positioned to contribute to reform delivery. 

Turning intent into funded, system-wide reform remains slow, held back by legacy funding models, siloed programs and risk-averse implementation. The reform space is active but it is far from settled. 

System pressure points 

The clearest signals about the direction of health reform come from systems under strain rather than from formal policy announcements. 

Disability, aged care and veterans’ health are operating under increasingly tight fiscal settings, constrained workforces and complex delivery arrangements. 

In each, the gap between reform ambition and delivery settings is now being tested in practice. In disability, the NDIS has shifted to lowering costs. 

The government is aiming to slow scheme growth to around five to six per cent through tighter scheme design, stronger market stewardship and pricing restraint. 

That shift was articulated at a system level in Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme Mark Butler’s National Press Club address and has since begun to translate into concrete settings. 

The first Annual Pricing Review of the government’s second term reduced physiotherapy pricing, further compressing already narrow operating margins. 

In response, the APA has focused on intervening at the level of policy inputs, commissioning independent analysis to examine the pricing methodology and engaging directly with the National Disability Insurance Agency as settings move from intent to implementation. 

As providers wait for the next Annual Pricing Review to land, this work has centred on highlighting the access and participation impacts already emerging under current settings. 

Thriving Kids, the first phase of Foundational Supports, will be a defining test of this approach. With significant investment committed and rollout beginning in late 2026, delivery models are now being shaped. 

The APA’s engagement is directed upstream, at commissioning design and service specification, to ensure physiotherapy is embedded as a core element of early identification, screening and multidisciplinary care, rather than positioned as a downstream service once models harden. 

In aged care, reform is increasingly characterised by implementation strain. 

While the new Aged Care Act lifts expectations, the underlying settings – pricing, assessment and workforce – remain poorly aligned with what delivery actually requires. Support at Home pricing continues to fall short of the cost of clinical physiotherapy, assessment tools override clinical judgement and workforce models under-recognise full-scope practice. 

In this environment, the APA’s policy focus has narrowed deliberately to the settings that most directly shape access and continuity: pricing design, assessment frameworks and workforce models capable of supporting consistent, clinically appropriate care.

Veterans’ access to physiotherapy is similarly shaped by funding sustainability. 

Current Department of Veterans’ Affairs fee settings have not kept pace with the cost of clinically appropriate care, placing pressure on provider participation. 

Survey data shows many practices delivering Department of Veterans’ Affairs-funded services at a loss, contributing to reduced availability and continuity, particularly for veterans with complex needs. 

The APA’s engagement in this space has concentrated on making these access consequences visible to the government, grounding discussions in workforce data and system impacts rather than service-level complaints. 

Work is underway to improve connectivity across the health system but allied health remains unevenly embedded in national digital infrastructure. While there is growing recognition that effective, patient-centred care requires allied health access to core digital tools, use of systems such as My Health Record and Individual Healthcare Identifiers remains inconsistent. 

Australian Digital Health Agency funding for an Allied Health Professions Australialed capability project reflects this gap. 

The APA’s involvement has highlighted both progress and persistent structural limitations, informing more targeted engagement with the government to ensure that physiotherapy is incorporated earlier in future digital health initiatives rather than retrofitted later. 

Where reform meets its limits 

Altogether, the emerging reform picture points to a widening gap between ambition and delivery. Scope of practice work and processes such as the Medicare Benefits Schedule Review reflect recognition of longstanding structural issues but they are advisory, incremental and unlikely to translate into rapid change.

In the meantime, outcomes across disability, aged care and veterans’ health are being shaped by more immediate forces in cost containment, pricing restraint and cautious implementation. 

These settings now exert far greater influence on access and continuity of care than reform processes still working their way through government machinery. 

For physiotherapy, the implications are clear. 

Expectations in terms of access and system performance continue to rise, while the conditions that support participation are tightening or left unresolved. Pricing and workforce settings are decisive. 

They determine whether supply grows, scope is utilised and markets function. 

These are the outcomes that follow directly from ministerial choices rather than market behaviour. 

This is not a question of reform intent but of alignment. 

Without changes to the settings that govern delivery, reform activity may continue while access and continuity move in the opposite direction.