Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme

Gemma Carey,Anne Kavanagh,Daniel Reeders,Eleanor Malbon,Gwynnyth Llewellyn

doi:10.1186/s12939-017-0682-z

Abstract

BackgroundIncreasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature.There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation.MethodsAs part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity.Results and discussionScheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities.ConclusionsThe research concluded that ‘personalisation’ approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages.

Highlights

It is well established that many of the key drivers of health reside in our everyday living conditions [1, 2]
In this paper we provide an overview of the Australian National Disability Insurance Scheme (NDIS)
The NDIS has the potential to secure gains in the wellbeing and health of hundreds of thousands of Australians, this can only be achieved with careful attention to the inequities above and others as they arise

Summary

Methods

As part of a longitudinal study on the implementation of the NDIS, we conducted a systematic document search of policy documents pertaining to the NDIS on the websites of government departments with auspice over the design and implementation of the scheme. In the case of market failure or thin markets, individuals already disadvantaged geographically are unlikely to be able to exercise true choice and control through personalisation It was mooted in the initial report recommending the NDIS that some ‘block funding’ by governments (i.e. the traditional contracting and procurement processes that currently exist) may continue: “block funding may continue in certain circumstances, such as in building community capacity, pilots of innovative services, in some rural areas where markets might not support the provision of any service, and where there is a need to build longer term capacity, such as Indigenous-specific services” [34]. It remains unclear how thin markets (and associated lack of choice and control) will be managed

Results and discussion

Introduction

Background

Conclusions