A new report has found the National Disability Insurance Scheme (NDIS) is reducing the use of some Medicare- funded health services, despite the scheme never being intended to replace or lessen demand for health care.
Established in 2013 to help Australians with disability live independently and participate in community and work life, the NDIS was designed to fund non-clinical and personalised supports.
However, the report shows the scheme is indirectly reshaping how participants engage with the wider health system.
Researchers analysed anonymous data from hundreds of thousands of NDIS participants, linking their NDIS records with Pharmaceutical Benefits Scheme prescriptions and Medicare Benefits Schedule claims.
The report examined GP and specialist visits, mental health and allied health services, and mental health prescriptions for up to 18 months after participants entered the scheme.
It compared participants living in areas where the NDIS rolled out early with those in areas where it rolled out later, attributing differences in service use to the scheme’s introduction.
According to the report, use of health services delivered exclusively by medical doctors – such as GP and specialist appointments or mental health-related prescriptions – did not significantly change after people joined the NDIS.
However, the report identified substantial declines in Medicare-funded services that overlap with supports commonly funded by the NDIS.
Medicare-subsidised mental health services fell by 13 per cent per participant per quarter, while Medicare-subsidised allied health services decreased by 8 per cent.
Although the individual reductions appear small, the report notes the national impact is considerable.
Using an average cost of $250 per mental health session, researchers estimated the decline in Medicare- funded mental health services equates to $10.6 million less Medicare spending each year and $16.3 million in reduced out-of-pocket costs – a combined $26.9 million reduction across roughly 700,000 participants.
The report concludes that NDIS-funded supports are replacing, rather than supplementing, some health care previously accessed through Medicare.
It found no evidence that participants’ health outcomes improved to the point that reduced Medicare use would be expected; for instance, GP visits – typically the first point of contact for health concerns – remained unchanged.
Instead, participants appear to be opting for NDIS-funded therapies, which the report notes are often more flexible, comprehensive and fully funded, compared with Medicare arrangements that limit the number of subsidised visits and frequently involve out-of-pocket expenses.
The Conversation
