Outreach or out-of-reach: Access to occupational therapy services in Australia

Access to occupational therapy (OT) services is essential for supporting Australians to participate in daily life, maintain independence, and achieve functional goals across home, school, work, and community settings.
Unlike many other health professions, OT practice often requires therapists to see people in the environments where they live, learn, and work. Functional assessments, home modifications, equipment prescription, early childhood intervention, school based support, and community participation planning all depend on understanding a person’s real world context. This means that travel is not optional or incidental to OT practice - it is a core component of safe, effective and person centred service delivery. While telehealth can be a useful adjunct, in many cases it is insufficient to meet all needs.
When OTs cannot travel, people in homes, schools, rural farms, supported accommodation, and remote communities are effectively left without access to essential therapy. Yet this report shows that access to OT is unevenly distributed and structurally inequitable, with geography, socioeconomic conditions, and population characteristics deeply shaping who can reach services and who cannot.
Using national road network travel times and the Enhanced Two Step Floating Catchment Area (E2SFCA) method, we examined OT service availability for every Statistical Area Level 1 (SA1) community in Australia (geographic blocks of approximately 200-800 people).
Together, these methods allow us to understand not only whether an OT is nearby, but whether local workforce capacity is sufficient for the populations who need services.
Key Findings
More than 550,000 Australians had no OT within 30-minutes’ drive
These residents had no practical access to basic OT assessment or intervention. This includes:
•126,548 children
•273,00 people with chronic conditions
•111,473 older adults
•88,311 First Nations people
•53,625 unpaid carers
•29,549 people requiring assistance with daily activities

These groups often had the highest need for functional support, home modifications, assistive technology, early intervention, and rehabilitation.
Access gaps fall overwhelmingly on rural and remote Australia
•93% of people without an OT within 30-minutes live in medium and small rural towns, remote, and very remote communities (Modified Monash Model (MM) Levels 4-7).
•Very remote communities (MM7), 64.1% of residents had no OT access within 30-minutes.

These patterns reflect structural spatial inequities, where service models and funding arrangements reflect metropolitan assumptions, leaving rural communities reliant on long distance outreach, limited local workforce, and fragile markets.
Nationally, 5.7 million Australians had low, very low, or no OT access within 30-minutes’ drive (MM1-3) or 60 minutes’ drive (MM4-7)
Even when broader catchments are included (60 minute drive allowance in MM4–MM7), the E2SFCA analysis showed substantial under supply:
•Only 46% of Australians fall in high or highest access categories.
•22.5% had low, very low, or no access to OT services.

This means OT workforce growth (74% over 9 years) has not translated into equitable distribution.
State and territory differences mirror broader structural patterns
•The ACT showed the highest access.
•Victoria, NSW, and Western Australia had moderate-to-high overall access but large regional gaps.
•Tasmania and Queensland showed more uneven distribution.
•The Northern Territory has the most severe shortage: almost 1 in 5 residents had no OT access.

First Nations Peoples face the lowest levels of access
•17.5% of First Nations residents had nil or very low access (vs 5.8% nationally).
•Only 34.4% of First Nations people had high or highest access (vs 47.4% nationally).

Many First Nations communities are located in remote and very remote regions where services are least available. These inequities reflect long-standing underinvestment rather than community characteristics.
Socioeconomic disadvantage compounds geographic inequity
OT access increases with socioeconomic advantage:
•In IRSAD Decile 1 (most disadvantaged), 9.3% had nil/very low access.
•In Decile 10 (most advantaged), only 1.5% had limited access.

This gradient demonstrated that communities with the fewest resources were also the least able to reach essential services.
Implications
The findings suggest that access inequities are predictable, systemic, and spatially patterned. The people and places most in need of OT due to complex intersecting needs, including, rural communities, First Nations people, children, older adults, and low income populations, are the least able to obtain it from an in-person occupational therapist.
Recent changes to NDIS travel reimbursement, which reduce billable travel time for therapists4, set a dangerous precedent for the financial sustainability of out-reach services. The realities of rural practice, including necessity for travel, the existence of thin markets, and limited workforce availability must be factored into funding policies.
These inequities cannot be solved by workforce growth alone3. They require targeted, place responsive policy action that recognises geographic disadvantage and corrects the structural conditions that currently limit equitable service provision.

Summary of Recommendations:
•Strengthen modelling of government funding to reflect geographic realities including analysis of distance and costs in rural and remote areas.
•Invest in a rural and remote OT workforce strategy with long-term system supports and rural pipeline development.
•Support First Nations led models of OT service delivery, strengthening community governance and local workforce pathways.
•Commission services in thin markets, including multidisciplinary outreach teams, rather than relying on fee for service viability.
•Prioritise disadvantaged communities (both urban and rural) for targeted investment.
•Improve national allied health workforce data to support evidence-based workforce planning.
•Adopt a national health service access index to guide equitable funding and infrastructure distribution.