Australia’s allied health sector – the cornerstone of therapeutic care across both the National Disability Insurance Scheme (NDIS) and Aged Care sector– is under siege. While policy reform is positioned as a path to fairness and sustainability, the pace, inconsistency, and financial ambiguity surrounding recent changes are not only exhausting providers but actively threatening the viability of the industry itself. In particular, providers delivering therapy services under the NDIS and emerging Support at Home program are facing untenable pressure points—financial, operational, and regulatory.
1. Foundational Supports: Aspirational Policy Meets Operational Risk
The NDIS review’s proposed Foundational Supports promise universal access to low-intensity interventions outside formal NDIS plans—an important recognition that not all disability support requires a full scheme plan. However, the rollout is riddled with ambiguity:
- No finalised funding model (Commonwealth vs State);
- No operational blueprint for referral pathways or delivery;
- No clear pricing schedule for providers.
For allied health, this is deeply destabilising. Nearly 50% of all therapy services currently fall into the “low intensity” category now deemed part of the foundational layer. Without committed funding, providers are effectively being asked to bet their financial future on a reform still being negotiated in principle.
Result: Providers are forced to either scale down their offering, shift out of these services entirely, or carry the financial risk—a choice that’s unsustainable long-term.
2. Support at Home Program: Pricing Reform That Misunderstands Cost
The Support at Home program, designed to replace the Home Care Package model, introduces a flat-rate pricing structure for services, aiming to simplify billing and reduce administrative burden. But simplicity has come at the cost of economic reality:
- Indicative pricing for allied health services ($160–$220/hour) doesn’t include enough margin for admin, supervision, compliance, or travel.
- Face-to-face delivery requirements fail to accommodate telehealth efficiencies or the growing need for flexible service models.
- Travel costs, especially in rural and remote areas, are inconsistently accounted for or excluded altogether unless pre-approved.
This approach, though perhaps well-meaning, grossly underestimates the true cost of delivering compliant, high-quality therapeutic care.
As one rural OT put it: “I’m driving two hours to provide a service that just barely covers fuel. And now I’m told to absorb that cost in the name of ‘client-centered’ care?”
3. The Pricing Problem: Chronic Under-Indexation and Stagnation
The financial unsustainability runs even deeper when we look at the broader pricing trajectory under the NDIS.
❗ The NDIS therapy pricing schedule is under-indexed by at least 5% — consistently lagging behind inflation, wage growth, and real-world cost increases.
❗ Therapy pricing for allied health has remained effectively stagnant for over six years, despite:
- Mandatory increases in award wages (e.g., Fair Work decisions);
- Rising service delivery costs (insurance, supervision, CPD, compliance);
- Heightened regulatory and quality assurance requirements (audits, outcome reporting, safeguarding frameworks).
Providers are being asked to maintain and even improve service quality while their funding is tethered to outdated pricing assumptions. The consequence is predictable: declining profitability, reduced service coverage, and increased workforce attrition.
4. Reform Fatigue: Compliance, Complexity, and Disincentives to Stay
Recent NDIS legislative reforms—such as mandatory invoice breakdowns, service declarations, and ‘fair pricing’ requirements—are intended to protect participants and improve oversight. But for providers, especially small and medium-sized practices, they represent a bureaucratic burden with no corresponding uplift in funding.
- The administrative workload continues to grow disproportionately.
- The sector is seeing an exodus of small providers unable to justify the overhead.
- Plan managers and intermediaries still soak up over $1 billion in NDIS funds annually, while front-line providers struggle to remain solvent.
This paints a stark picture: the system is choking the providers who actually deliver the care, while middle-layer administration remains bloated and under-scrutinised.
5. The Cost of Inaction: Shrinking Access and Market Exit
With foundational supports underfunded, Support at Home pricing out of step, and NDIS rates under-indexed, we are already seeing the impacts:
- Regional and remote providers are downsizing or exiting;
- Waitlists for therapy services are growing;
- New graduates are steering away from disability and aged care due to unviable pay and caseload expectations.
Participant “choice and control” only exists if there’s a provider left in the market to choose from.
A Path Forward: Realism Must Replace Rhetoric
To stop the haemorrhaging of the allied health sector, governments and funders must act decisively:
- Implement automatic annual indexation of NDIS therapy rates aligned with wage and CPI growth.
- Revise Support at Home pricing to reflect true cost of service, including admin, supervision, and travel.
- Fund foundational supports immediately with a ring-fenced budget and clear operational model.
- Streamline compliance processes to focus on quality outcomes, not just documentation volume.
- Redirect funding from intermediaries toward front-line service delivery where value is actually created.
Final Thought: Fatigue Isn’t a Soft Problem—It’s a Hard Economic Signal
What’s happening in allied health isn’t just provider frustration—it’s a macroeconomic warning. The core economics of disability and aged care therapeutic service delivery are no longer aligned with policy vision.
If we continue on the current path, reforms intended to enhance quality and equity will instead deliver scarcity and fragmentation. And once providers exit, rebuilding the system won’t just be expensive—it will be near impossible.
This isn’t “burnout.” It’s structural industry fatigue, where the business model itself is being eroded to the point of collapse.
