The NDIS at ten years: designing an equitable scheme for the next decade

To the Editor: We fully support Smith‐Merry and colleagues’ call for increased attention to equity in the National Disability Insurance Scheme (NDIS).1 The authors highlight the potential for the NDIS to exacerbate social and economic inequalities between people with disability living in urban areas compared with rural areas if the implementation of the NDIS is not carefully monitored.

Rural Australians tend to have poorer health outcomes than their urban counterparts, and the proportion of people with disability increases as one moves further from cities.2 These health inequities are often socially determined and reflect poor access to primary and preventive care.3 People with disabilities experience poorer health outcomes than those without disabilities, largely due to disadvantaged circumstances such as poverty and discrimination.2 This means rural Australians with disabilities are doubly disadvantaged, leading to poorer health outcomes.

In addition, there are inequities within rural areas. For instance, rural Aboriginal and Torres Strait Islander people have larger plan size but lower utilisation compared with the rest of the rural population.3

Currently, there is a lack of infrastructure to examine life outcomes for people with disability who are not on the NDIS. Social, economic and health outcomes may be worse in this group because of the lack of services in rural areas.

Measuring and monitoring inequalities in key outcomes is essential but not enough to ensure that the NDIS effectively narrows the existing gaps in health, social and economic participation between people with and without disabilities. To achieve this, detailed linked administrative and disability data are required. These data will allow us to tease out what is causing worse health for people with disability. Without understanding cause and effect we cannot know which policy changes will have the largest health and equity gain. These data need to cover as much of the disabled population as possible, not just those on the NDIS. To improve the quality and comparability of data across sources, having a “disability identifier” in mainstream data collections is crucial.4

In conclusion, addressing equity in the NDIS implementation is critical to ensure that it benefits all Australians with disabilities, regardless of where they reside.