Disabled Australians need the NDIS to be viable

The National Disability Insurance Scheme, currently assisting 160,000 Australians with disabilities, is projected to cater for 475,000 people when it reaches full strength, at a cost to taxpayers of $23 billion a year, in July 2020. In the interim, the National Disability Insurance Agency is taking the opportunity to ensure the viability of the scheme by reviewing and tweaking operations and costs. This is eminently responsible but the process is painful and controversial, as Rick Morton reports today. The agency is concerned about wide variations in charges for therapeutic services such as occupational therapy, speech pathology, physiotherapy and psychology across the country. It is on the right track in seeking to cap costs and should persevere for the sake of sustaining a scheme disabled people and their loved ones need, and for the sake of taxpayers who pay for it.

The NDIA price cap for services is $175 an hour. But the review undertaken by McKinsey & Company and released in March recommended breaking that into three tiers, with the lower two costing $110 and $140 an hour depending on services required. Providers, predictably, are unhappy about the mooted reform, which could also leave some clients out of pocket. Three months ago, Occupational Therapy Australia chief executive Rachel Norris wrote to the head of the NDIA, Rob De Luca, warning him the changes “threaten … the very viability of the NDIS”. So would a situation in which costs soared out of control. Ms Norris said hundreds of service providers were set to cancel their NDIA registration. Representatives of physiotherapists and speech pathologists have issued similar warnings about the consequences of tiered pricing.

After reasonable negotiations however, the NDIA needs to resist such pressures. The NDIS cannot operate as a bottomless pit. Costs need to be contained. Given wide disparities in NDIS clients’ needs and the severity of their conditions, tiered pricing for different treatments makes sense. As part of its review, McKinsey benchmarked the NDIS prices against similar systems in which therapists provide services, such as WorkSafe and the Department of Veterans’ Affairs. It found rates varied from $90 to $200 an hour. Pricing pressures also vary between states and regions, according to the number and availability of professional providers, which is why a degree of flexibility should be built into the system.

It is also vital, as The Australian has pointed out consistently, that the scheme be contained to disabled Australians with severe problems. Mild autism cases, for example, are not the NDIS’s core concern. Some individuals and families, inevitably, will be disappointed if they are denied admittance. Others may be disappointed by the level of assistance they receive. As the client base almost trebles across the next two years, difficult choices will be inevitable if the NDIS is to be viable in the long term.