Gatekeepers or advocates? Occupational therapists and equipment funding schemes

The profession of occupational therapy has a long history of prescribing, selecting and creating assistive devices to enhance the occupational performance of people with disabilities. Historical reviews of occupational therapy practice throughout the twentieth century describe the prominence of equipment prescription as a therapeutic approach and the complexity and integration of information needed in the prescription of equipment (Anderson & Bell, 1988; Hocking & Wilcock, 1997). A key aspect of equipment prescription that significantly influences recommendations by a therapist is an awareness of how the equipment will be funded and the realities of the funds available. The key Australian bodies that provide funding to purchase equipment for children and adults with disabilities are the statemanaged schemes. These state-managed schemes have been in place since 1987 when the Commonwealth Government transferred funding for equipment to the states and territories (Cranny, 1998). Since that time, different schemes have evolved in all states and territories resulting in variations in a range of policies and procedures. This means that the states and territories may have different eligibility criteria, preferred items, cost ceilings, payment systems and prescriber requirements (Ernst & Young, 1996).In New South Wales (NSW), Australia, the state-managed scheme is called the Program of Appliances for Disabled People (PADP). This scheme is administered by the NSW Department of Health and has been designed to provide equipment for children and adults with disabilities. Although the scheme provides equipment for all children with a disability, adult applicants are means-tested, resulting in the provision of equipment being based on financial disadvantage. Many of the other state-managed programs in Australia also state that eligibility is aimed at people who can demonstrate 'financial hardship' (Australian Institute of Health and Welfare, 2003). This Viewpointfocuses on this aspect of 'financial hardship' within the PADP scheme and discusses the role the occupational therapy profession may play in the continuation of this inequitable system. Although particular reference is made to the PADP, this Viewpoint may have relevance for other state- or territory-managed schemes within Australia.