Research Article Regional and remote occupational therapy: A preliminary exploration of private occupational therapy practice Judith Merritt, David Perkins and Frances Boreland Centre for Remote Health Research, Department of Rural Health, Broken Hill University, Broken Hill, New South Wales, Australia Background/aim: Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational ther- apy practice in rural and remote Australian settings is sparse. Methods: Providers of private occupational therapy ser- vices in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings. Results: Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents. Conclusions: There is a potential market failure of pri- vate occupational therapy in rural and remote areas, impacting on people who need these services and on work- force replacement. Contributing factors include population imbalance between cities and regional/remote areas, finan- cial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regio- nal/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private pro- viders to overcome barriers to providing student place- ments and recognising rural practice as a specialist field. KEY WORDS primary health care, private practice, rural/remote. Introduction Occupational therapists assist people of all ages to over- come limitations caused by injury, illness, psychological or emotional difficulties, developmental delay, disability and the effects of ageing (Allied Health Professions Australia, 2010). Services are provided as part of a multi- disciplinary team under a Primary Health Care (PHC) model which incorporates health promotion, illness pre- vention, providing direct treatment and care to people, community development, advocacy and rehabilitation (PHCRIS, 2010). There is a national shortage of occupa- tional therapists (Australian Health Workforce Advisory Committee, 2006) with specialised positions difficult to fill and shortages in regional and remote areas. The impact (if any) that shortages of occupational therapists in rural and remote areas has on provision of primary health-care services and on people’s health is not known. Private occupational therapy practitioners have been defined as self-employed therapists functioning as inde- pendent business people for tax purposes (Courtney & Farnworth, 2003). Sources of income for private occupa- tional therapists in Australia include Medicare, Depart- ment of Veterans Affairs (DVA), workers compensation authorities and motor vehicle accident insurers. Defini- tive workforce data on private occupational therapy pro- viders are not currently available as national registration was not in place when the research was undertaken. The viability and sustainability of private occupational ther- apy practice outside of major city areas is not known. Private occupational therapists are a crucial part of the Australian PHC system (DOHA, 2010), providing Medicare funded services to children and adults with chronic disease, disability or mental health issues. Peo- ple living outside of major cities have higher needs for Judith Merritt GCertEd (TTeach), MHlthSci (OT), BAppSci (OT); Allied Health Academic. David Perkins PhD, BA; Associate Professor. Frances Boreland MPH (Hons), BA (Biol) (Hons); Research Officer. Correspondence: Judith Merritt, Centre for Remote Health Research, Department of Rural Health, Broken Hill Univer- sity, P.O. Box 457, Broken Hill, NSW 2880, Australia. Email: jmerritt@gwahs.health.nsw.gov.au Accepted for publication 9 March 2013. © 2013 The Authors Australian Occupational Therapy Journal © 2013 Occupational Therapy Australia Australian Occupational Therapy Journal (2013) 60, 276–287 doi: 10.1111/1440-1630.12042