Authors: Bernice Hua Ma 1,2, Samia Badji1,2, Gang Chen, PhD1, Dennis Petrie, PhD1,2
1 Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
2 Centre for Research Excellence in Disability and Health, Parkville, VIC, Australia
Approximately 10% of Australians with disability report unmet health care needs. The National Disability Insurance Scheme (NDIS) provides personalised funding to support people with their individual needs and goals. Recent research finds that some healthcare services, such as mental and allied health services, are less utilised under Medicare for NDIS participants after they join the NDIS. This may be because the NDIS also covers similar services. However, it did not significantly affect the use of healthcare services funded under only Medicare but not the NDIS, such as GP and specialist visits. Additional strategies to address issues of unmet needs and healthcare barriers need to be considered by policymakers.
People with disability often face significant barriers to accessing healthcare, such as not having enough information, additional costs, mobility limitations, stigmatization, and communication hurdles. Researchers from the Centre for Health Economics, Monash University, and Centre for Research Excellence in Disability and Health, Parkville, Victoria examined the impact of enhanced social care provided through the NDIS by comparing the health outcomes of those who entered the NDIS early with those who entered late using linked data. The results showed that the NDIS reduced subsidised mental health services by 13% and allied health services by 11% in the six quarters after enrolment. These effects were most pronounced among participants aged 0-24 years, males, and those living in major cities. Because of the lack of change in GP visits and the evidence of the NDIS outcome report, the authors concluded that the reduction in mental health and allied health services was likely to be a substitution effect, in that while participants may have much greater control over the services they purchase, they are using the same services. Given there was no evidence of change in other healthcare use it is likely that the NDIS has not been able to break barriers of healthcare access in the short run.
On the public system level, substituting from Medicare to the NDIS can result in higher expenditure to the public system as the practitioners may charge the NDIS patients more for various reasons, and there is not a limitation of how many times per year NDIS participants could access subsidised care. However, if the NDIS provides better quality care, it may save the public costs in a long run because the health conditions or quality of life of people with disability may improve from better social services.
There are heated debates around the blown-out costs of the NDIS. Substitution effects and potential long-term savings should not be ignored when such budgets and expenditures are discussed.