The NDIS funds reasonable and necessary supports that help a participant to reach their goals, objectives and aspirations, and to undertake activities to enable their social and economic participation. The NDIA makes decisions about what supports would be reasonable and necessary based on the National Disability Insurance Scheme Act 2013 (NDIS Act) and the rules comprised in this. Operational guidelines also provide practical guidance for NDIA staff on what supports are considered reasonable and necessary. In this section we present quantitative and qualitative evaluation evidence on the KEQs that relate to the broad theme of reasonable and necessary.The chapter considers the extent to which NDIS participants and their carers are satisfied that their supports are reasonable and necessary and how this has changed over time.
Satisfaction with Supports Being ‘Reasonable and Necessary’ – Evidence from Large Scale Surveys
The quantitative data includes a measurement of the satisfaction that NDIS participants and their carers have that current disability supports are reasonable and necessary.
In wave 1, a majority of NDIS participants (75 per cent) and their carers (84 per cent) were either satisfied or very satisfied that their current disability supports were reasonable and necessary (Appendix Tables A5.1 and A5.3). This compares to 58 per cent of people with disability in the comparison group.
In wave 2, there was very little change in the proportion of either NDIS participants or carers who were either satisfied or very satisfied that their current disability supports were reasonable and necessary (Appendix Tables A5.2 and A5.3). The proportion of people with disability from the comparison group reporting satisfaction with their supports in wave 2, however, decreased to 45 per cent.
A largely positive picture emerges from the data, with a majority of NDIS participants in both waves reporting that they consider their supports to be reasonable and necessary. However, as with other measures of satisfaction (e.g. the number of supports), there is a minority of people who do not consider the supports they access to be reasonable and necessary; this remained steady at about nine per cent of NDIS participants in waves 1 and 2 (Appendix Tables A5.1 and A5.2).
Having choice and control over disability supports is strongly connected with satisfaction that these supports are reasonable and necessary.
As shown in Appendix Tables A5.4 and A5.5 there is an association between the reported level of say that NDIS participants have over their supports and the degree to which they believe that the NDIS funded supports they access can be considered reasonable and necessary. Hence, most NDIS participants who felt that they had a lot of choice and control over their supports also reported being satisfied that these supports were reasonable and necessary.
The Impact of the NDIS on Satisfaction with Supports Being ‘Reasonable and Necessary’ – Evidence from Large Scale Surveys
Further analyses explored the impact of the NDIS on satisfaction with supports being considered to be reasonable and necessary. The impact of the NDIS was measured by considering the difference in satisfaction among NDIS participants and the comparison group. Several estimation methods and model specifications were used to obtain robust overall results. Estimation details and results can be found in the Appendix.
5.3.1 Reasonable and necessary: what do NDIS participants think?
The impact of the NDIS on satisfaction with supports being reasonable and necessary was estimated to be large and highly statistically significant. For adult people with disability, the NDIS was estimated to increase the probability of being ‘very satisfied’ that supports were reasonable and necessary by 83 per cent (or 30 percentage points as reported in Appendix Table A5.6).
The impact of the NDIS on the satisfaction that supports were reasonable and necessary for children with disability, as reported by carers, were equally large and statistically significant with an estimated impact of 51 per cent (Appendix Table A5.9).
People with disability who were experiencing unmet demand for supports were less likely to report that their supports were reasonable and necessary (21 per cent less likely on average) (Appendix Table A5.12 and Appendix graph A5.7 and Figure 5.8).
The impact of the NDIS on satisfaction with supports being reasonable and necessary was the same for urban and rural adult residents. For children with disability, however, satisfaction levels were slightly higher for the urban sample.
Estimation results (using the continuous measure of satisfaction) show some heterogeneity in the impact of the NDIS on satisfaction that supports were reasonable and necessary by disability type. Figure 5.1 illustrates this heterogeneity showing the lowest estimated impact of the NDIS to be 11 per cent for adult people with an intellectual disability followed by a 17 per cent impact for people with psychosocial disability. The estimated impact of the NDIS on perceptions that supports were reasonable and necessary was highest for people with developmental/congenital disability (29 per cent).
Figure 5.1 Person with disability: Impact of NDIS on satisfaction that supports are ‘reasonable and necessary’ by broad disability category (Trial, Adults)
Figure 5.2 compares the estimated individual impact of the NDIS on perceptions of reasonable and necessary supports for people with mental/psychosocial disability with those with another disability type. This is illustrated by comparing the distribution of the impact collectively for each group. The mean impact of the NDIS on satisfaction with supports being reasonable and necessary was significantly lower for participants with a mental/psychosocial disability.
Figure 5.2 Person with disability: Impact of NDIS on satisfaction that supports are ‘reasonable and necessary’ by disability type (Trial, Adults)
The impact of the NDIS on satisfaction that supports were reasonable and necessary (as shown by the blue line in Figure 5.3) differed by the age of the NDIS participant. In particular, the impact of the NDIS was greatest for teenage participants. The dotted red line in the figure represents the estimated 95 per cent confidence intervals of this impact.
Figure 5.3 Person with disability: Estimated impact of NDIS on satisfaction that supports are ‘reasonable and necessary’ by age of NDIS participants (Trial, Adults)
Figure 5.4 shows that the impact of the NDIS on perceptions of reasonable and necessary supports varied by how long the NDIS participant has been participating in the NDIS. Beyond about 30 months of participation, however, this estimate becomes unreliable as the very broad confidence intervals suggest.
Figure 5.4 Person with disability: Estimated impact of NDIS on satisfaction that supports are ‘reasonable and necessary’ by the length of NDIS participation (Trial, Adults)
5.3.2 Reasonable and necessary: what do carers think?
The impact of the NDIS on the satisfaction of carers that supports are reasonable and necessary is somewhat smaller than that estimated for people with disability themselves; the estimated impact, however, is still clearly strong and statistically significant (Appendix Tables A5.8 and A5.9 on the binary measure, and, Appendix tables A5.10 and A5.11 on the continuous measure).
We then examined the impact of the NDIS on carer satisfaction of supports being reasonable and necessary according to the main disability type of the adult person with disability they care for (Figure 5.5). The highest impact was found for carers of adults with intellectual and developmental disability and the lowest for those caring for a person with mental/psychosocial disability.
Figure 5.5 Carers: Impact of NDIS on carer satisfaction that supports are ‘reasonable and necessary’ by disability (Trial, Adults, continuous measure)
The impact of the NDIS on supports being considered reasonable and necessary by carers according to the main disability type of the child they care for is presented in Figure 5.6. Unlike with adult participants, there no discernible differences by type of disability.
Figure 5.6 Carers: Estimated conditional ATET for carers of people with disability (Trial, Age 0 – 15, continuous measure)
The impact of the NDIS on the satisfaction of carers that supports are reasonable and necessary was positive regardless of the age of the person with disability they cared for (Figure 5.7). Positive impacts on carer satisfaction increased for NDIS participants up to the age of 10 years and decreased thereafter (left panel of Figure 5.7). For the carers of adult participants (right panel of Figure 5.7), the higher the age of the participant, the lower the impact of the NDIS was on satisfaction with supports being reasonable and necessary. The lowest impacts overall were seen for carers of NDIS participants who were aged 60 – 65 years.
Figure 5.7 Carers: Impact of NDIS on carer satisfaction by person with disability age group (continuous measure) (Trial)
5.3.3 Reasonable and necessary: duration in the NDIS and different cohorts of participants
We then examined two further questions about satisfaction with supports being reasonable and necessary. First, does satisfaction increase with time spent in the NDIS? This is a ‘duration’ question about whether each individual participant is achieving improved outcomes as they become more familiar with the NDIS and the NDIS becomes more familiar with their needs. This process will be reflected through differences captured between the earlier and the later outcomes of each participant. Second, are the later cohorts of participants entering the NDIS more likely to find their supports to be reasonable and necessary than the earlier cohorts? This is a ‘cohort’ question about whether the NDIS is evolving as it gains more experience; this evolution is reflected in the difference between the outcomes of earlier and later new participants. These two questions can be confused as the earlier ‘cohorts’ will also be the ones with the longest ‘duration’. In order to disentangle this issue, multivariate regression approaches were used. The key findings from these analyses are presented below (Figure 5.8 and Appendix Table A5.12).
People with disability who joined the NDIS early (in the first half of 2014) were less likely to report that their supports are reasonable and necessary. No further ‘cohort’ effects were found in the data.
The longer that NDIS participants are in the NDIS, the more likely they are to be satisfied that their supports are reasonable and necessary (about 9 per cent more likely with each year spent as an NDIS participant).
The full results of the multivariate regression are depicted in Figure 5.8 below. These estimated effects should be interpreted as estimates of association and not as causal estimates. The horizontal axis measures the effect of each factor included in the estimation; those in blue (to the right) are positively associated with satisfaction, while those in orange (to the left) are negatively associated with satisfaction.
Differences by disability type and unmet demand experiences were statistically significant. NDIS participants with a physical, neurological or mental/psychosocial disability were especially more likely to be satisfied that their supports were reasonable and necessary, while those with an intellectual disability or experiencing unmet demand for supports were less satisfied.
Those who were born with their disability were more likely to say that their supports under the NDIS are reasonable and necessary.
Figure 5.8 Person with disability: Estimating the probability to be satisfied with reasonable and necessary (Trial, Adults)
