Upload
dina-austin
View
213
Download
0
Tags:
Embed Size (px)
Citation preview
1
Sarah Johnson – Scheme Actuary
Lisbon, Portugal
July 2015
European Social Network Conference
National Disability Insurance Scheme - Australia
2
An insurance-based approach
Journey to the NDIS
Scheme experience
Agenda
Building a sustainable scheme
4
Strategic goals
People with disability are in control and have choices, based on the UN Convention on the Rights of Persons with Disabilities.
The National Disability Insurance Scheme is financially sustainable and is governed using insurance principles.
The community has ownership, confidence and pride in the National Disability Insurance Scheme and the National Disability Insurance Agency.
5
• The NDIS is based on the principles of insurance
• The risk of disability affects all Australians.
• The NDIS is a way of pooling these risks.
• Australians pay a premium (collectively) that is enough to cover the annual costs of the care and support needs of participants and the costs of running the scheme.
A disability insurance scheme
Scheme funding$$$$$$
$$$
$$$
Participants and familiesConsolidated revenue (taxes)
6
• The aggregate annual funding requirement will be estimated by
the Scheme Actuary
• The NDIS will focus on lifetime value for scheme participants
• The NDIS will invest in research and innovation
• The NDIS will support the development of community capability
and social capital
Insurance Principles
7
• Once a participant is in the scheme, the NDIS is liable for their lifetime cost
• Factors influencing lifetime liability: packages of support and changes to these packages, inflation (including wage rates), life expectancy
• NDIS “average” participant: $35,000 average annual package and $1.2 million liability (lifetime liability 35 times the annual cost on average)
Liability
Lifetime Cost of Participant
Pastpayments Expected future payments
8
• Collect data on the number of participants, the characteristics of these participants , the outcomes for these participants, and the cost of supports provided to participants
• Identify drivers of good and bad outcomes – benefits to participants, their families and the community
Monitoring and managing financial sustainability
Participant outcomes and scheme costs
Factors contributing to deviations
Mainstream services
Family and friends
GeographyCommunity
inclusiveness
Participant characteristics (e.g. reference
groups)
Service Providers
Availability of supports
Cost of supports
10
History
2008: Government’s 2020 summit proposes a national disability
scheme
December 2012: Council of Australian Governments
sign an intergovernmental agreement to trial the Scheme
March 2013: NDIS Act 2013
establishing the NDIS and NDIA passed
April 2013: Bilateral
agreements with trial sites signed
Heads of Agreement are now in place for full scheme in NSW, SA, ACT, Tas, Vic and
Qld
2009: The Disability
Investment Group released its findings in
The Way Forward
2010: Productivity
Commission conducts enquiry into long term
disability care
July 2011: Productivity
Commission submits report to government
October 2011: Council of Australian
Governments agree to the need for reform – joint
taskforce develops Scheme design
Since 1 July 2013, the NDIS trial has been operating in:
• South Australia (0-14 years)
• Tasmania (15-24 years)
• Hunter region, New South Wales
• Barwon region, Victoria
Trial sites are established and expanding
On 1 July 2014, the NDIS trial commenced in:
• Australia Capital Territory
• Barkly region, Northern Territory
• Perth Hills region, Western Australia
13
Profile of participants - Age
0%
10%
20%
30%
40%
50%
60%
00-14 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65+ yrs
Dis
trib
uti
on
Age group
NSW VIC ACT NT WA Expected %
• 30-35% are children aged 0-14 years
• The age distribution in the Australian Capital Territory and Western Australian trial sites reflects the phasing schedules of the trial sites.
14
Profile of participants - Gender
• The proportion of males and females is consistent with the actuarial model for the New South Wales, South Australian, Tasmanian and Victorian trial sites.
• The new trial sites have relatively more males than females due to the specific age groups currently in these trial sites.
Female, 40%
Female, 29%
Female, 36%
Female, 41%
Female, 36%
Female, 40%
Female, 35%
Male, 60%Male, 57%
Male, 71%Male, 68%
Male, 64%Male, 63%
Male, 59%Male, 58%
Male, 64%Male, 55%
Male, 60%Male, 48%
Male, 65%Male, 57%
Other, 0.1%
0% 20% 40% 60% 80% 100%
ActualExpected
ActualExpected
ActualExpected
ActualExpected
ActualExpected
ActualExpected
ActualExpected
NS
WS
AT
AS
VIC
AC
TN
TW
A
Distribution
15
Profile of participants – primary disability
• Autism and related disorders and intellectual disability (including Down syndrome) are the largest primary disability groups in the New South Wales and Victorian trial sites.
22%22%
5%5%5%
0% 5% 10% 15% 20% 25%
autism and related disordersintellectual disability
cerebral palsyother neurological disorders
schizophreniadown syndrome
developmental delaydeafness/hearing loss
global developmental delaymultiple sclerosis
acquired brain injuryother physical disorders
other psychiatric disordersother sight loss
strokeother sensory/speech disorders
physicalintellectual disability - mild
Other
Distribution
Pri
mar
y d
isab
ilit
y
NSW
23%22%
7%6%
5%
0% 5% 10% 15% 20% 25%
intellectual disabilityautism and related disorders
developmental delayschizophrenia
other psychiatric disordersdown syndrome
cerebral palsyglobal developmental delay
multiple sclerosisbipolar affective disorder
acquired brain injuryintellectual disability - mild
other neurological disordersstroke
other sight lossphysical
deafness/hearing lossother physical disorders
Other
Distribution
Pri
mar
y d
isab
ilit
y
VIC
16
Implementation issues
• Transition from existing disability system to the NDIS
• Legacy of existing systems evident in trial site
experience to date
• Move from block funding to invoicing
• Support provided in kind
18
• 419,500 people across Australia, at a total cost of $14.7 billion (2013/14 figures)
• Split into cohorts based on age, health condition, and level of functional support need
• Reference packages:
• provide an expected annual funding level for participants with similar support needs and characteristics
• a link between resource allocation to individual participants and the overall funding envelope
• a crucial role in scheme monitoring
Reference groups - background
19
Modelling of reference groups
Intellectual Disability$3 billion
Low Severity$2 billion
Medium severity
…
High Severity
…
0-14 year olds
$1 billion
14-24 year olds$0.5
billion
…
Stroke$0.5 billion
Low severity$0.2 bn
…
Total Funding Envelope
$14.7 billion
20
Legislation• support social and economic participation of people with
disability • choice and control• maximise independence• facilitate greater community inclusion
Other documents:• Strategic plan• UN Convention on the Rights of People with a Disability• National Disability Strategy
Outcomes framework - background
21
Different goals may be relevant at different life stages.
To allow for this changing focus, unique sets of questions
have been developed for each age group:
1. Children from birth to school entry
2. Children from school entry to age 14
3. Young people aged 15 to 24
4. Adults aged 25 to 55
5. Older adults aged over 55.
Outcomes framework – life stages
22
Adults
The adult frameworks consist of eight participant domains and five family domains.
The participant domains are:
1.Choice and control
2.Daily activities
3.Relationships
4.Home
5.Health and wellbeing
6.Lifelong learning
7.Work
8.Social, community and civic participation
Outcomes framework - adults
23
The family/carer domains are:
1. Families have the support they need to care
2. Families know their rights and advocate effectively for their family member with disability
3. Families are able to gain access to desired services, programs, and activities in their community
4. Families have succession plans
5. Families enjoy health and wellbeing
Outcomes framework – families/carers
24
• Ongoing bilateral negotiations between states/territories and the
Commonwealth government
• Agreements likely in place in August 2015
• Around 30,000 participants at the end of the trial, ramping up to
460,000 at full scheme
• Focus on enduring data collections and reducing the need for
frontline staff to collect data that may be available from other
sources
• Building a national footprint
Transition to full scheme