By bobb |

Tom Burton

Governments need to stop encouraging private providers to find repeat customers in the care sector and make a paradigm shift to a model that builds in support across the disability, aged care and rehabilitation sectors, social policy experts say.

A new paper from the Actuaries Institute said care economy models that sought to create a private marketplace of services which governments fund, meant there was little incentive to get people off publicly funded support.

Actuaries say early childhood education support for autism is a more effective intervention rather than support payments based on medical diagnosis. Getty

Market-driven government services which enable users to “shop” for publicly funded services were popular in the early 2000s. They were embraced in the employment, healthcare, aged care, worker rehabilitation and disability sectors to try to create competitive and cost-effective supplier markets for social services.

“The current market model for providers incentivises repeat customers, not the provision of high-quality and outcomes-driven services which lead to scheme exits where appropriate – this is a conundrum for the entire care market (aged care, disability and injury/rehab),” Maathu Ranjan and Dr Anthony Lowe said.

Ms Ranjan is a Roland Wilson PhD scholar at the Australian National University on leave from the National Disability Insurance Scheme. She is studying the impact of autism on the NDIS. Dr Lowe is the former CEO of NDIS service provider TAD Australia.

Ms Ranjan said the current NDIS model medicalised neural diversity rather than offering autistic children support through the education and community sectors that encouraged them to live full lives in society.

“It needs to move away from the medical model towards a social model where it’s embedded into everyday standards,” Ms Ranjan told The Australian Financial Review.

“It seeks to change society so that it can accommodate people who are living with disability, but it doesn’t seek to change people with a disability to then accommodate society.”

The actuaries said a wealth of research showed quality early childhood intervention is effective when led by parents within school and community settings.

“We can find efficiencies and likely higher quality care and improved outcomes if supports for children with developmental concerns are embedded in mainstream pathways.”

How to best support childhood autism has emerged as a central issue for the NDIS review being undertaken by former chairman Bruce Bonahady and previous education secretary Lisa Paul. Explosive growth has forced the Albanese government to cap the scheme’s expansion to 8 per cent per year.

Over a third (215,000) of all current NDIS plans (611,000) are for autism conditions, according to the latest NDIS quarterly report.

The actuaries said 11 per cent of 5 to 7 year-old boys and 5 per cent of 5 to 7 year-old girls are NDIS participants. There are now over 313,000 participants under the age of 18, accounting for more than half the scheme population and a fifth of NDIS costs.

“Children, particularly children with autism or developmental delay, are one of the fastest growing cohorts of NDIS participants – this is largely because the system gives families little choice but to seek out formal medical diagnoses,” said Ms Ranjan.

The actuaries said many schemes have trialled ways to financially motivate providers to focus on individual outcomes.

“Outcomes are difficult to measure and then linking outcomes with funding is also difficult to do,” Ms Ranjan said.

The paper said it is difficult to “commodify outcomes” and may even result in another way for providers “to game the system”, particularly for children where a range of different interventions in various settings may prove effective.“

The challenge was to transform provider markets into one that assesses function, measures outcomes and focuses on what people could do and support them to have good lives, as opposed to focusing on what they can’t do in order to get entry to the scheme and get a package.

“It would shift the way that an individual will be able to access support,” Ms Ranjan said.

“In order to do that needs a huge governmental shift. That’s not something that’s going to happen overnight. It’s not an easy thing to do.”

She said leadership would be needed from the national cabinet.

”They need to think about the interconnected nature of the current system.”

Professor Bonyhady has admitted many providers are over-charging and over-servicing.

“There is collusion and, in some cases, outright fraud, and that plan management and support coordination are not always playing the roles that were intended,” he said in a recent speech

“That is why we’re considering payment approaches – other than fee-for-service – that deliver better outcomes for people with disability.

“Support for families has largely been ignored. There has been a focus on diagnosis rather than support needs. These failings – together with the lack of supports for all children with disabilities in mainstream settings – is undermining the sustainability of the NDIS,” Professor Bonyhady said.


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