Government plans to use NDIS purchasing power to help save billions – but they shouldn't put products before people

Last week’s federal budget included a A$732.9 million investment^[1] to get the National Disability Insurance Scheme (NDIS) “back on track^[2]”. In the next four years, there are also plans for a $15.3 billion reduction in NDIS costs.

One area of focus is assistive technology^[3], an umbrella term^[4] that covers products – from glasses to communication devices to wheelchairs^[5] – and the systems and services necessary for their delivery. Getting assistive technology right is vitally important for an effective NDIS because the return on investment is up to nine times what is spent^[6]. Assistive technology enables people to do what’s important to them, including work and study.

Pre-budget announcements^[7] flagged this focus and the 2023–24 budget^[8] provides further detail. Reportedly, some $2.5 billion^[9] in projected savings will come via proposed^[10] initiatives including “preferred provider arrangements to leverage [NDIS] buying power” and an “assistive technology expert advisory panel”.

These targets are ambitious and there are important considerations for them to be successful.

Putting the person first

There are internationally recognised steps^[11] for assistive technology provision. The first is that the supply of assistive technology is person-centred^[12], not product or service-centred. This is because to get good outcomes, individual goals and needs^[13] should drive product selection, rather than a person’s needs being “fitted” to an existing product. The latter goes against good assistive technology practice^[14] and could worsen NDIS participant outcomes.

The value of assistive technology support funding^[15] committed in NDIS participant plans – $1.38 billion at the end of last year – points to an opportunity to exert buying power and save money. However, purchasing strategies – which may include bulk buying^[16] assistive technology at discount prices – could lead to unintended consequences.

Risks include restricting^[17] product selection or inadvertent market price fixing. It also means the government may wind up with a warehouse full of equipment waiting to be matched to a user, rather than the products scheme participants really require.

The current approach – using an evidence-based list^[18] of product categories that guides NDIS participants and providers clarity on the options available – is more suitable.

For example, personal alarms can useful to alert others to the need for assistance but the reasons for assistance depend on the person. Disability-related needs, such as seizure and falls management, fire detection, alerts for phone calls or visitors, and orientation or memory prompts, should guide product selection.

Read more: NDIS cost scrutiny is intensifying again – the past shows this can harm health and wellbeing for people with disability^[19]

The right advice can be complex and cost more

When assistive technology is more complex or high risk^[20], it is recommended participants seek advice from allied health professionals.

Some assistive technology advisory services – such as state-based Independent Living Centres – were lost when they fell through funding gaps^[21] that emerged when the NDIS was implemented.

This means people will most often get advice from product suppliers or when they contract advice from allied health providers. But hourly rates for allied health services funded by the NDIS have been labelled as “price gouging^[22]” by leaders including NDIS Minister Bill Shorten. The suggestion here is that the same service is being charged at a much higher rate for NDIS participants. But this is incorrect. It fails to take into account the complexity and cost of NDIS work, or gap amounts paid for other allied health services, like those provided through private health insurance or chronic disease programs^[23].

When it comes to assistive technology and home modifications, the trained technical expertise, necessary insurances, professional supervision and administrative processes required make delivery highly complex^[24] and costly.

For example, for an occupational therapist to codesign vehicle modifications with a wheelchair user, there are seven practice steps and three sets of stakeholders that need to be engaged^[25] to deliver a good outcome.

NDIS participant and provider expertise should be central

There are reports that a proposal to leverage buying power for assistive technology would rely on an advisory panel^[26], something like the Pharmaceutical Benefits Scheme that negotiates medicine prices.

But expert advisory panels, such as those in other disability and injury management schemes^[27], are typically staffed by health professionals.

NDIS participants must be partners in panel design^[28]. Any advisory panel should include people who use assistive technology, as well as health professionals who advise on it.

Read more: From glasses to mobility scooters, 'assistive technology' isn't always high-tech. A WHO roadmap could help 2 million Australians get theirs^[29]

Nothing about us without (any) of us

The NDIS relies on informed and empowered participants and an effective and efficient provider market.

The most effective way to curb spending will be for the National Disability Insurance Agency (which administers the NDIS) to codesign processes with people with disability and their support network – sometimes called “need knowers^[30]” – and any advisers they choose to engage. They can help identify reasonable and necessary assistive technology and get the best value for money.

Correction: The wording in this story’s headline and content has been changed from “bulk buying” to “purchasing power” to align with reporting in the government’s 2023–2024 Budget Measures Paper.

References

1. ^{^} A$732.9 million investment (budget.gov.au)
2. ^{^} back on track (budget.gov.au)
3. ^{^} assistive technology (budget.gov.au)
4. ^{^} umbrella term (www.who.int)
5. ^{^} glasses to communication devices to wheelchairs (theconversation.com)
6. ^{^} nine times what is spent (atscalepartnership.org)
7. ^{^} announcements (ministers.dss.gov.au)
8. ^{^} budget (budget.gov.au)
9. ^{^} $2.5 billion (www.smh.com.au)
10. ^{^} proposed (ministers.dss.gov.au)
11. ^{^} internationally recognised steps (www.who.int)
12. ^{^} person-centred (www.arata.org.au)
13. ^{^} individual goals and needs (pubmed.ncbi.nlm.nih.gov)
14. ^{^} good assistive technology practice (www.arata.org.au)
15. ^{^} assistive technology support funding (www.ndis.gov.au)
16. ^{^} may include bulk buying (www.smh.com.au)
17. ^{^} restricting (www.accc.gov.au)
18. ^{^} list (www.ndis.gov.au)
19. ^{^} NDIS cost scrutiny is intensifying again – the past shows this can harm health and wellbeing for people with disability (theconversation.com)
20. ^{^} more complex or high risk (www.ndis.gov.au)
21. ^{^} fell through funding gaps (www.smh.com.au)
22. ^{^} price gouging (www.smh.com.au)
23. ^{^} private health insurance or chronic disease programs (www.health.gov.au)
24. ^{^} highly complex (www.health.vic.gov.au)
25. ^{^} seven practice steps and three sets of stakeholders that need to be engaged (www.mdpi.com)
26. ^{^} advisory panel (www.smh.com.au)
27. ^{^} injury management schemes (www.tac.vic.gov.au)
28. ^{^} partners in panel design (www.ndis.gov.au)
29. ^{^} From glasses to mobility scooters, 'assistive technology' isn't always high-tech. A WHO roadmap could help 2 million Australians get theirs (theconversation.com)
30. ^{^} need knowers (ndsp.com.au)