Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme

Authors: Gemma Carey, Eleanor Malbon, Daniel Reeders, Anne Kavanagh, Gwynnyth Llewellyn

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

Increasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature.
There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation.

Methods

As part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity.

Results and discussion

Scheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities.

Conclusions

The research concluded that ‘personalisation’ approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages.
Appendix
Available only for authorised users
Footnotes
1
There are discrepancies in the documents made available to the public. For example, not all quarterly reports from the National Disability Insurance Agency to the Council of Australian Governments can be found on government websites. Requests to obtain documents were unsuccessful.
 
Literature
1.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35:80.CrossRef
2.
CSDH. Closing the gap in a generation. Geneva: WHO; 2008.
3.
Marmot M. Fair society, healthy lives: the marmot review. Strategic review of health Inequalitites in England post-2010. London: Institute for Health Equity; 2010.
4.
Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64:284–91.CrossRefPubMedPubMedCentral
5.
Coburn D. Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities. Soc Sci Med. 2004;58:41–56.CrossRefPubMed
6.
Mackenbach JP. Political determinants of health. The European Journal of Public Health. 2014;24:2–2.CrossRefPubMed
7.
Wilikson R, Pickett K. The Spirit level. Allen Lane: UK; 2009.
8.
Carey G, Crammond B. Action on the social determinants of health: views from inside the policy process. Soc Sci Med. 2015;128:134–41.CrossRefPubMed
9.
Baum F. Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health. Promot Educ. 2007;14:90–5.CrossRefPubMed
10.
Baum F. From norm to Eric: avoiding lifestyle drift in Australian health policy. Aust N Z J Public Health. 2011;35:404–6.CrossRefPubMed
11.
Friel S. Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy. International Journal of Health Policy Management. 2014;3:1–3.CrossRef
12.
Friel S, Marmot M. Social determinants of global health equity. Annu Rev Public Health. 2011;32:225–36.CrossRefPubMed
13.
Baum FE, Laris P, Fisher M, Newman LA, MacDougall C. Dear health minister: tend the garden but make sure you fence the crocodiles. J Epidemiol Community Health. 2014;68:295–6.CrossRefPubMed
14.
Baum FE, Laris P, Fisher M, Newman L, MacDougall C. “Never mind the logic, give me the numbers”: former Australian health ministers’ perspectives on the social determinants of health. Soc Sci Med. 2013;87:138–46.CrossRefPubMed
15.
Raphael D. Beyond policy analysis: the raw politics behind opposition to healthy public policy. Health Promot Int. 2014;
16.
Smith K. Beyond evidence-based policy in public health: Palgrave Macmillan; 2014.
17.
Carey G, Friel S. Understanding the role of public Administration in Implementing Action on the social determinants of health and health inequities. International Journal of Health Policy and Management. 2015;4:795–8.CrossRefPubMedPubMedCentral
18.
Carey G. Re-Conceptualising public health interventions in government: a response to recent commentaries. International Journal of Health Policy Management. 2016;5:567–70.CrossRef
19.
Carey G, Crammond B. A glossary of policy frameworks: the many forms of “universalism” and policy “targeting.”. J Epidemiol Community Health. 2017:303–7.
20.
Benach J, Malmusi D, Yasui Y, Martínez JM. A new typology of policies to tackle health inequalities and scenarios of impact based on Rose’s population approach. J Epidemiol Community Health. 2013;67:286–91.CrossRefPubMed
21.
22.
World Health Organization. World report on disability. Geneva: WHO; 2011.
23.
Bureau of Statistics. Disability, ageing and Carers: summary of findings, 2015. Canberra: Commonwealth Government of Australia; 2015.
24.
Kavanagh AM, Krnjacki L, Aitken Z, LaMontagne AD, Beer A, Baker E, et al. Intersections between disability, type of impairment, gender and socio-economic disadvantage in a nationally representative sample of working-aged Australians. Disability and Health Journal. 2015;8:191–9.CrossRefPubMed
25.
Emerson E, Llewellyn G, Honey A, Kariuki M. Lower well-being of young Australian adults with self-reported disability reflects their poorer living conditions rather than health issues. Aust N Z J Public Health. 2012;36:176–82.CrossRefPubMed
26.
Emerson E, Madden R, Graham H, Llewellyn G, Hatton C, Robertson J. The health of disabled people and the social determinants of health. Public Health. 2011;125:145–7.CrossRefPubMed
27.
Mithen J, Aitken Z, Ziersch A, Kavanagh AM. Inequalities in social capital and health between people with and without disabilities. Soc Sci Med. 2015;126:26–35.CrossRefPubMed
28.
State Government of Victoria. Victorian population health survey of people with an intellectual disability 2009. Victoria, Australia; 2011.
29.
Esping-Anderson G. Three worlds of welfare capitalism. London: Polity Press; 1990.
30.
Navarro V, Shi L. The political context of social inequalities and health. Soc Sci Med. 2001;52:481–91.CrossRefPubMed
31.
Askheim OP. Personal assistance for disabled people–the Norwegian experience. Int J Soc Welf. 1999;8:111–20.CrossRef
32.
Askheim OP, Bengtsson H, Richter BB. Personal assistance in a Scandinavian context: similarities, differences and developmental traits. Scand J of Disability Res. 2014;16:3–18.CrossRef
33.
34.
Australian Productivity Commission. Disability care and support: productivity commission inquiry report. Melbourne, Vic.: Productivity Commission; 2011.
35.
Hill M, Hupe P. Implementing public policy. Second Edition. London: Sage; 2009.
36.
LeGrand J. Delivering public services through choice and competition: the other invisible hand. Princeton University Press: Princeton; 2007.
37.
Hood C. The idea of joined-up government: a historical perspective. In: Bogdanor V, editor. Joined-up government. Oxford: Oxford University Press; 2005. p. 12–42.
38.
Klijn E-H, Koppenjan J. Public management and policy networks. Public Management. 2000;2:437–54.CrossRef
39.
Needham C, Glasby J. Personalisation – love it or hate it? J of Integr Care. 2015;23:268–76.CrossRef
40.
Williams I, Dickinson H. Going it alone or playing to the crowd? A critique of individual budgets and the personalisation of health Care in the English National Health Service: individual budgets and the personalisation of health care. Aust J of Publ Administration. 2016;75:149–58.CrossRef
41.
Anttonen A. Universalism and the challenge of diversity. In: Anttonen A, Haikio L, Stefansson K, editors. Welfare state, universalism and diversity. Cheltenham: Edward Elgar; 2012. p. 1–15.CrossRef
42.
Riddell S, Pearson C, Jolly D, Barnes C, Priestley M, Mercer G. The development of direct payments in the UK: implications for social justice. Social Policy and Society. 2005;4:75–85.CrossRef
43.
Giaimo S, Manow P. Adapting the welfare state the case of health care reform in Britain, Germany, and the United States. Comp Political Stud. 1999;32:967–1000.CrossRef
44.
45.
46.
Needham C, Dickinson H. “Any one of us could be among that number”: Comparing the Policy Narratives for Individualized Disability Funding in Australia and England. Social Policy & Administration [Internet]. 2017 [cited 2017 Jun 5];Online first. Available from: http://​doi.​wiley.​com/​10.​1111/​spol.​12320.
47.
Thill C. Listening for policy change: how the voices of disabled people shaped Australia’s National Disability Insurance Scheme. Disability & Soc. 2015;30:15–28.CrossRef
48.
Collings S, Dew A, Dowse L. Support planning with people with intellectual disability and complex support needs in the Australian National Disability Insurance Scheme. J Intellect Dev Disabil. 2016;41:272–6.CrossRef
49.
Carey G, Kay A, Nevile A. Institutional legacies and “sticky layers”: what happens in cases of transformative policy change? Administration & Society 2017;95399717704682.
50.
Walsh J, Johnson S. Development and principles of the national disability insurance scheme. Australian Economic Review. 2013;46:327–37.CrossRef
51.
52.
Whalan J, Acton P, Harmer D. A review of the capabilities of the national disability insurance agency. NDIS: Canberra, Australia; 2014.
53.
54.
Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for the application of proportionate universalism. Int J Health Equity. 2015;14
55.
Thompson S, Hoggett P. Universalism, selectivism and particularism: towards a postmodern social policy. Critical Social Policy. 1996;16:21–42.CrossRef
56.
Bonyhady B. The NDIS vision: delivering the plan. St Laurence National Conference; 2014.
57.
58.
Soldatic K, van Toorn G, Dowse L, Muir K. Intellectual disability and complex intersections: marginalisation under the National Disability Insurance Scheme. Research and Practice in Intellectual and Developmental Disabilities. 2014;1:6–16.CrossRef
59.
Brennan C, Rice J, Traustadóttir R, Anderberg P. How can states ensure access to personal assistance when service delivery is decentralized? A multi-level analysis of Iceland, Norway and Sweden. Scandinavian Journal of Disability Research. 2017;19:334–46.CrossRef
60.
NDIA. Quarterly report to COAG disability reform council June 2015. Victoria: National Disability Insurance Agency; 2015.
61.
Commonwealth Department of Social Services. Proposal for a National Disability Insurance Scheme Quality and safeguarding framework. Canberra: Commonwealth Government of Australia; 2015.
62.
Department of Social Services. In: National Disability Insurance Scheme Quality and Safeguards Framework. Commonwealth of Australia: Consultation Report; 2016.
63.
Department of Social Services. NDIS quality and safeguarding framework. Canberra: Commonwealth of Australia; 2016.
64.
Department of Social Services. Integrated market, sector and workforce strategy. Canberra: Commonwealth Government of Australia; 2015.
65.
LeGrand J, Bartlett W. Quasi-markets and social policy. London: Macmillan; 1993.
66.
Considine M, Lewis JM. Networks and interactivity: ten years of street-level governance in the United Kingdom, the Netherlands and Australia. Public Management Review. 2012;14:1–22.CrossRef
67.
Spicker P. Understanding particularism. Crit Social Policy. 1994;13:5–20.CrossRef
68.
Considine M, Lewis JM, O’Sullivan S. Quasi-markets and service delivery flexibility following a decade of employment assistance reform in Australia. J Social Policy. 2011;40:811–33.CrossRef
69.
Needham C. Debate: personalized public services—a new state/citizen contract? Public Money & Manage. 2010;30:136–8.CrossRef
70.
Glasby J, Littlechild R. Direct payments and personal budgets: putting personalisation into practice. Bristol, UK: Policy Press; 2009.
71.
Bornat J, Leece J. Developments in direct payments. Bristol, UK: Policy Press; 2006.
72.
McLean G, Sutton M, Guthrie B. Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK quality and outcomes framework. J Epidemiol Community Health. 2006;60:917–22.CrossRefPubMedPubMedCentral
73.
74.
Piccenna L, Chee M, Lewis V, Gruen RL, Bragge P. Briefing document: Optimising self-directed funding for the long-term disabled. NTRI Forum: Melbourne, Australia; February 2015.
75.
NDIS. Report on the sustainability of the scheme. Commonwealth Government of Australia: Canberra; 2016.
76.
Hart J. The inverse care law. A Sociology of Medical Practice. 1975;189
77.
Lorenc T, Petticrew M, Welch V, Tugwell. What types of interventions generate inequalities? Journal of Epidemiology and Community7.
78.
79.
Douglas J, Bigby C, Knox L, Browning M. Factors that underpin the delivery of effective decision-making support for people with cognitive disability. Res Pract Intellectual Dev Disabilities. 2015;2:37–44.CrossRef
80.
O’Connor DB, Jones F, Conner M, McMillan B, Ferguson E. Effects of daily hassles and eating style on eating behavior. Health Psychol. 2008;27:S20.CrossRefPubMed
81.
Sen A. Commodities and capabilities. OUP; 1999.
82.
Commonwealth Department of Social Services. Proposal for a National Disability Insurance Scheme Quality and safeguarding framework: consultation paper. Canberra: Commonwealth Government of Australia; 2015.
83.
Girth A, et al. Outsourcing public service delivery: management responses in noncompetitive markets. Public Administration Research. 2012;72:887–900.CrossRef
84.
NDIS. Victorian market position statement. NDIS; 2016.
85.
NDIA. ILC consultations - summary report. National Disability Insurance Agency: Victoria; 2016.
86.
87.
Alliance NRH. Income inequality experienced by the people of rural and remote Australia. NRHA: Canberra; 2014.
Metadata
Title
Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme
Authors
Gemma Carey
Eleanor Malbon
Daniel Reeders
Anne Kavanagh
Gwynnyth Llewellyn
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0682-z

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue

Research

Trends in healthcare expenditure among people living with HIV/AIDS in the United States: evidence from 10 Years of nationally representative data

Research

“I’m not strong enough; I’m not good enough. I can’t do this, I’m failing”: a qualitative study of low-socioeconomic status smokers’ experiences with accessing cessation support and the role for alternative technology-based support

Research

Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study

Research

Occupational status as a determinant of mental health inequities in French young people: is fairness needed? Results of a cross-sectional multicentre observational survey

Erratum

Erratum to: Effect of socioeconomic conditions on health care utilization in marital violence: a cross-sectional investigation from the Japanese Study on stratification, health, income, and neighborhood

Research

Up close and real: living and learning in a remote community builds students’ cultural capabilities and understanding of health disparities