Organisations adapting to dual aspirations of individualisation and collaboration in the National Disability Insurance Scheme (NDIS) market

Abstract

Disability support is often provided at the interface with other human services such as health, education, and employment agencies. This can present many organisational problems for people receiving support and the organisations that provide it. Individualised funding is one attempt to ease problems of fragmentation and unmet needs, but perversely, it introduces further interface complexities as organisations consider how to manage their service provision and financial structures.Drawing on interviews with 28 managers, the focus in this paper is on organisational and interface changes and challenges following the introduction of the National Disability Insurance Scheme (NDIS) in Australia, and the adaptive strategies of organisations to provide individualised and coordinated supports. The three themes derived from the thematic analysis, adopting a commercial mindset, finding a business niche, and working across complex interfaces, epitomise the benefits, constraints, and consequences of new market mechanisms for the delivery of supports, and how organisations are adjusting to a more commercial-orientated sector while also creatively negotiating multiple funding and governance systems.

NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review

“…However, this limited research reveals that formal support systems are inadequate [ 5 , 16 , 18 , 22 , 54 ] despite the multiple service providers involved in the lives of people with SPMI [ 14 , 17 , 51 ]. Furthermore, even though mental health, NDIS, and palliative care providers share person-centred values [ 15 , 19 , 40 , 92 , 93 ], collaboration between providers, though highly recommended and encouraged, is poor, limited or non-existent [ 15 , 16 , 18 , 21 , 22 , 27 , 38 , 40 , 53 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ]. The NDIS does not fund case management or care coordination, a recognised and highly valued role in mental health systems [ 100 , 101 ], to the detriment of NDIS participants with complex support needs.…”

“…Similar to trends in human services in some European countries, the Australian Government designed the NDIS to deliver individualised or self-directed support to people with disabilities [ 95 , 113 ]. These funding models help empower NDIS participants [ 114 ] and ratify Australia’s obligations under the UNCRPD [ 35 ].…”

“…Providers are reporting that they must work around the NDIS rules to survive financially [ 34 ]. The conflict between quality and profit has negatively impacted their organisations’ missions, making NDIS participant relationships transactional [ 34 , 95 ]. Due to insecurity around income, the financial risks to businesses have caused NDIS providers to restructure their business models to ensure financial viability.…”

“…Due to insecurity around income, the financial risks to businesses have caused NDIS providers to restructure their business models to ensure financial viability. As NDIS participants can change NDIS providers with limited notice, they are curating the types of disability supports offered to reduce these financial risks [ 95 , 117 ].…”

Young people in residential aged care: Is Australia on track to meet its targets?

“…It has also been suggested that transitioning to a market‐based scheme, although improving service access and quality for some people with disability, might disadvantage others (Backhouse, 2017; Carey et al, 2018; Muir & Salignac, 2017). Market forces can have unintended consequences, with potential risks of, for example, market gaps for certain services (Carey et al, 2018), “cream‐skimming” of high value customers (Backhouse, 2017), disincentives for inter‐provider collaboration (Foster et al, 2021; Green et al, 2018) or exploitation of vulnerable participants (Russi, 2014). Although various mechanisms exist to regulate and “steward” the market (Carey et al, 2018), it is conceivable that unintended market dynamics could have emerged and affected numbers in RAC.…”