Same Same Different Series - Disability & Aged Care [#1 - The Levers]

Envelopes come in many sizes, but only so much can fit inside before something gives!

I sit here having spent the last 3 years immersed in disability services as it leads the greatest social change since Medicare with the introduction of NDIS. I was immersed primarily in aged care for the previous 10 years. I can’t help but reflect on the challenges (and opportunities) facing these sectors and conclude it is ‘same same but different’.

Put simply whilst there are very similar (and few!) levers that can be pulled by Government under disability and aged care funding to adjust how the funding system plays out, the ones being selected and the order and way these levers are being pulled is different. I would argue, they are profoundly different. This is interesting to watch and tricky for providers, and Government, to manage and proactively address. The final impact is always on the client, their families and/or the community as a whole when one or other lever is pulled too hard, or not pulled sufficiently.

Over a 3-blog spread, I will share my thoughts via the Same Same Different Series.

Blog 1 - what are the levers?

Blog 2 – what and how are levers being pulled in disability services and in aged care, with what impacts?

Blog 3 – the verdict: which system is better, if any?

The funding levers represented as a diagram

1. Eligibility – this is all about increasing or decreasing the inflow of clients into the funding system. It can happen by changing the criteria as to who can enter or by changing the speed of entry/commencement of services. This is a powerful and immediate tool.

2. Package Size – this is self-explanatory; however, it can include variances such as making the package size variable rather than fixed or changing the inclusions within the package.

3. Price Paid to Provider – this can include whether the price is set by Government or whether it is market driven. It also includes how the price is set by either Government or the market.

4. Rules Governing the Nuances or Quality of the Service – this is where the Government tweaks the rules or methodologies which can impact package inclusions or the like. It also includes quality requirements which may be tightened and therefore increase or change reporting, accreditations and process obligations.

5. Size of the Funding Envelope – this can include Government funding and client co-contribution methodologies including means testing. It can also include whether Government funding is segregated and guaranteed or whether it is subject to annual bidding or budget cycles.

Factors 6 and 7, while not direct levers, are critical to system sustainability and the way the whole dynamic of the system plays out, including whether providers want to enter the market or not.

6. Consumer Expectation & Participation – the degree to which a consumer, and or their advocate/family, participate in shaping their support packages and monitor the delivery of services is an indirect factor which influences the system and sometimes changes the extent of levers being pulled or otherwise.

7. Other Influencers – these can include unions, advocacy groups and other parties which are indirectly part of the system and therefore their ability to organise key issues to become important can influence the way the whole system works.

Whilst there are only 7 levers, there are thousands of outcomes that can be achieved by pulling the levers in different priority order and to different extents. Blog 2 will talk about these across the disability and aged care systems and how the same things are being applied differently.