Social Work - Theses

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    Informing NDIS market stewardship through consumers’ information preferences: An exploratory study
    Beecher Kelk, Aviva Elisabeth ( 2020)
    Australia’s policies have historically seen many people with disability (PWD) confined to institutions, abused, neglected and systemically denied the right to self-determination (Barnes & Sheldon, 2010; Oliver, 1992). It follows that many PWD have typically lacked choice over which services are involved in their lives. An ideology of choice has emerged in the context of publicly funded disability services, influenced by ideas associated with neoliberalism and new public management (Fotaki et al., 2008). Some welfare-state services have been “personalised” (Needham, 2011), such as Australia’s National Disability Insurance Scheme (NDIS), which uses a marketplace model to offer consumers choice about what support to purchase (Fawcett & Plath, 2014). The NDIS is not a conventional market in a neoclassical sense – it is a quasi-market, seeking a way to manage considerations of both efficiency and equity. Within this context, there is an important role for “market stewardship” to balance these tensions (Carey, Reeders, et al., 2018). Choice can create not only self-determination for consumers, but a burden (Glendinning, 2008), and information is required to support the process of NDIS decision-making. However, there is limited evidence about what information is required. In this regard, a significant gap exists in the market stewardship literature, especially around knowledge that is driven by consumer preferences rather than provider or government priorities. This research explores what information is required for NDIS consumers to feel informed when choosing service providers. It is a social work practice research study, examining a problem identified through practice with the aim of addressing it (Sim et al., 2018). Data was collected in two phases. The first utilised semi-structured interviews (n=23) to explore informational issues in depth while gathering data to inform the construction of a survey. This survey comprises the second phase, extending the sample to test the generalisability of the results (n=201). Results show that word of mouth information from trusted interpersonal relationships is valued, as is information from and about professionals. This suggests that decades of oppression of PWD and professionalisation of service navigation have resulted in consumers’ mistrust regarding information from service providers and government (Walsh, Wilson, Baines, & Martin, 2012), which is compounded by the complexity of the new NDIS system (Malbon, Carey, & Reeders, 2018). Participants therefore rely on trusted peers and professionals for reliable information. This reliance is problematic because it stalls capacity building for both consumers and providers and decreases the urgency to implement market stewardship interventions. Furthermore, it can lead to riskier decision-making and poorer outcomes (Hakansson & Witmer, 2015; Schul & Peri, 2015) and relies on consumers having strong social networks, which puts equity outcomes at risk as well as the success of the insurance scheme. This thesis contributes new knowledge to the market stewardship literature and also to practice. Academic findings are described above. Practical recommendations include deprofessionalising service navigation in order to decrease the information asymmetry that exists; using peer advisors to distribute information throughout the sector; helping providers create trustworthy information through their marketing collateral; creating sector-wide metrics; investing in shared digital solutions in order to collate and distribute information; and localising NDIS governance so as to create rich local information.