The implementation of the ambitious National Disability Insurance Scheme (NDIS, or the scheme) has been marked by significant delays in the budget allocation of its participants.
The urgency in solving these issues is great: soon after the election win earlier this year, Prime Minister Morrison vowed to prioritise NDIS issues, including delays in the design and review of individual plans.
Such implementation delays derive from the scheme’s innovative personalisation approach, which aims to promote participant choice and control by funding personal goals and aspirations.
For the scheme, this translates to the personalisation of budgets, designed in conjunction with National Disability Insurance Agency (NDIA, or the agency) representatives, through in-depth interviews.
But what constitutes success in personalisation for large-scale policymaking? And are there ways to reduce delays in designing and reviewing individual plans as the scheme rolls out to meet its target of 460,000 NDIS participants by mid-2020?
Efficiency, consistency and quality
First, to address rollout delays, the NDIA must promote more efficient approaches to the design and review of personal plans. Whereas in-depth interviews are still considered the most appropriate technique for identifying people’s subjective goals and aspirations, reports show that relying only on this technique is leading to significant delays in scheme’s implementation, sometimes of up to nine months.
Reports also reveal that, urged to meet enrolment targets, NDIA representatives are conducting interviews over the phone.
Second, the power of in-depth interviews is best captured as interview questions adjust to accommodate the answers of respondents. This flexibility implies that interviews conducted by different interviewers may lead to significant differences in how personal funds are allocated. Anecdotal evidence also reveals that, urged to meet enrolment targets, NDIA representatives are conducting interviews over the phone, compromising the quality of NDIS plans. Whereas we advocate for the personalisation of budgets, we propose that consistency is also a key constituent of success for the NDIS rollout.
Third, personalisation in the scheme requires the design of high-quality NDIS plans. Recent investigations suggest a lack of expertise of NDIA agents, who approve inadequate plans in favour of increasing the number of enrolments in the scheme.
Better-quality plans are advantageous both because they provide the best solutions to scheme participants and for reducing the need for additional iterations between participants and the NDIA.
To address the delay in NDIS plans, the government has proposed the NDIS Participant Service Guarantee — an initiative that sets shorter timeframes for eligible participants to set and review their plans.
But how can this initiative remedy the delay in scheme rollout, while promoting efficiency, consistency and better-quality plan outcomes?
Designing large-scale personalisation
We propose the use of frontier approaches to segment demand in the NDIS. Our view is that, to promote personalisation, it is important to understand how people make choices in the disability sector.
For example, examining demand for disability supports based on how people make choices and what their goals are, as well as whether they are consumers (v. carers), urban dwellers (v. residents in remote areas), older (v. younger) and full-time work participants (v. other types of work arrangements).
To address the need for more efficiency, consistency and better-quality plan outcomes, the Institute for Choice, Capital Markets Cooperative Research Centre and National Disability Services piloted a study that drew from concepts (e.g., social psychology, behavioural economics), methods (e.g., discrete choice experiments) and analytical techniques (e.g., choice modelling) to test the applicability of such large-scale approach in the sector.
The main exercise for this segmentation consisted of a discrete choice experiment that systematically manipulated characteristics of two ‘new’ service providers available to respondents, which varied across multiple-choice situations.
As a pilot study, we tested our approach with 286 eligible NDIS consumers and carers.
The survey was tailored to respondents’ disability types, regional backgrounds, service requirements and their respective costs.
Note that, rather than a representative sample of respondents in the disability sector, our objective in this pilot was to test whether we could identify different choice patterns (demand) in the disability sector, based on current NDIS parameters.
Our test pilot successfully identified two distinct types of decision-makers, summarised in Figure 1.
Figure 1. Identifying different needs.
The first segment of decision-makers adopted a Remedial frame of mind when making choices in the disability sector.
They focused on specific disability-related issues and prioritised service immediacy. They composed 51% of the sample and were more likely to be older than the second segment.
Remedial decision-makers favoured supports related to the nursing of complex needs and therapies to help physical, mental and social needs in the Scheme.
Their expected willingness to pay was higher when providers offered immediate booking (vs. waiting up to two months for an appointment) and 5-stars quality ratings (vs. 1-star).
Quality-of-life decision makers, the second segment, composed 49% of the sample.
These individuals prioritised service quality descriptors, seemed to adopt a preventative-choice mindset and were more focused on longer-term outcomes. They were also more likely to be part-time workers.
They prioritised supports towards changing concerning behaviours and help with managing their disability support.
Quality-of-life frame of mind favoured improvements in star ratings and experience with their disability type when selecting amongst service providers.
Further, the Quality-of-life segment presented higher willingness-to-pay, possibly reflective of their preference for individualised services (note: in the Scheme, individualised services costs are generally higher within their respective service categories).
A comparison of the two segments shows that consumers and nominated carers were just as likely classified into either segment.
However, their personal goals influenced the adoption of Remedial or Quality-of-life frame of mind.
For example, carers pursuing the goal “have a good, happy or fulfilled life” and consumers pursuing the goal “maintain or improve physical health” were more associated with the Remedial segment.
On the other hand, consumers in the Quality-of-life segment tended to give more importance to the goal “avoid gaining weight/ lose weight”, whereas carers rated more highly the goals “maintain of build new relationships” and “avoid poor mental health”.
Innovating to deliver
The success of the NDIS depends on developing more efficient, more consistent and higher-quality NDIS plans.
Our pilot has shown that this can be achieved by adopting innovative approaches to segmentation, even as the Scheme is still being rolled out and existing data on customer choice are lacking.
Rather than replacing in-depth interviews, we propose reconciling these interviews with an approach more suited to examining demand on a large scale.
We believe in budget personalisation to promote choice and control in the disability sector. However, this personalisation should not deter Australians from accessing their required services, supports, therapies and interventions.