Authors: Crocker M,1 Hutchinson C,1 Mpundu-Kaambwa C,1 Walker R,2 Chen G,3 and Ratcliffe J1
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA 5001, Australia
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA 5001, Australia
- Centre for Health Economics, Monash University, Melbourne, Melbourne, Caulfeld East, VIC 3145, Australia.
The National Disability Insurance Scheme (NDIS) represents the most significant policy change in the disability support sector in Australian history. Researchers at Flinders and Monash Universities developed an online survey investigating the relative importance ranking of 12 quality of life dimensions (e.g. sleep, pain, mental health, physical mobility, hearing, vision, safety, self-care, dignity, control, social relationships, and independence). Of the 853 adult Australian respondents, about half (n=410, 48%) identified as a person with a disability. ‘Control’ ranked most important for people with a disability.
Comparing the quality of life dimensions revealed that people with a disability placed more importance on broader-quality of life dimensions (e.g. control, independence and self-care) than on health-related aspects (e.g. vision, hearing, sleep).
The Australian government estimates that the number of people receiving NDIS support to increase to over 530,000 in the next few years. According to recent Federal budget forecasts, NDIS expenditure is predicted to overtake the cost of Medicare within three years. Against this background, health economic evidence is key to the financial sustainability and success of the NDIS. Evaluation requires services and supports to be accurately costed; additionally, they must represent value for money in improving the quality of life and well-being outcomes for people with a disability.
Quality of life instruments is commonly used assessment tools to measure a person’s quality of life. Some instruments focus on health-related aspects of quality of life (e.g. pain, mobility, anxiety and depression), whilst others focus on broader characteristics of quality of life (e.g. independence, dignity). Others have been designed for application in specific populations (e.g. children or older people), reflecting that as people age, their preferences for what is essential to a good life may change. However, little is known about differences in quality of life preferences between those with and without a disability. Our work is an important precursor to applying quality of life instruments in evaluating value for money and the cost-effectiveness of services and supports within the NDIS.
Further, results confirmed that the greatest difference in preference weighting between people with and without a disability was for the ‘Vision’ dimension. Overall, people with a disability placed ‘Vision’ and ‘Hearing’ as the two least important aspects (relative to the other ten dimensions) which affect their quality of life.
Related to this study, a group of scholars at Monash University, the University of Sydney and Flinders University are currently developing a new Disability Wellbeing Index (DWI) – a project funded by NDIA and led by my co-author Assoc. Prof. Gang Chen at Monash University. It’s hoped that the DWI will become a powerful tool to measure the well-being of people with disability.