Disability support is often provided at the interface with other human services such as health, education, and employment agencies. This can present many organisational problems for people receiving ...support and the organisations that provide it. Individualised funding is one attempt to ease problems of fragmentation and unmet needs, but perversely, it introduces further interface complexities as organisations consider how to manage their service provision and financial structures. Drawing on interviews with 28 managers, the focus in this paper is on organisational and interface changes and challenges following the introduction of the National Disability Insurance Scheme (NDIS) in Australia, and the adaptive strategies of organisations to provide individualised and coordinated supports. The three themes derived from the thematic analysis, adopting a commercial mindset, finding a business niche, and working across complex interfaces, epitomise the benefits, constraints, and consequences of new market mechanisms for the delivery of supports, and how organisations are adjusting to a more commercial-orientated sector while also creatively negotiating multiple funding and governance systems. The findings contribute to understandings of how individualisation is creating new dynamics of local disability support governance and collaboration in service provision.
As recently as 15 years ago, the high level of Disability Insurance (DI) enrollment was considered to be one of the major social and economic problems of the Netherlands; indeed, the Netherlands was ...characterized as the country with the most out-of-control disability program of OECD countries. But since about 2002, the Netherlands has seen a spectacular decline in its Disability Insurance enrollment rate. Radical reforms to the Dutch DI system were implemented over the period 1996 to 2006. We cluster these reforms in three broad categories: 1) reducing the incentives of employers to move workers to disability; 2) increased gatekeeping; and 3) tightening disability eligibility criteria while enhancing worker incentives. The reforms appear to have been very effective. Since 2002, yearly DI inflow rates dropped from 1.5 percent in 2001 to about 0.5 percent of the insured population in 2012. We argue that particularly the interaction of employer incentives and formal employer obligations has contributed to the substantial decrease in DI inflow. On the downside, however, it seems workers with bad health have sorted into temporary employment—without employers bearing the financial responsibility of their benefit costs.
A key goal of the NDIS, the federally funding individualised funding scheme for people with a disability in Australia, is to facilitate an ordinary life for them in their communities. This study ...examined family perceptions of the contribution NDIS made to create an ordinary life for their adult member with intellectual disability. Semi-structured interviews were conducted with 20 families. The families found this to be a complex process in that while the move to the new funding system supported some elements of a life more aligned to that of similar aged peers, there were also a number of missed opportunities. The opportunities that were available to the adult with intellectual disability were affected by stakeholders' differing views of disability. NDIS presents an opportunity to continue to build towards enabling people with a disability to make their own choices and, with support when needed, build a life similar to their peers.
Points of interest
The National Disability Insurance Scheme (NDIS) is the new federal individualised funding scheme for people with a disability in Australia.
The National Disability Insurance Scheme gives people with a disability their own funding. This helps them to be able to make their own choices about what they want to do and what support they need.
The National Disability Insurance Scheme hopes to support an ordinary life for people with a disability in their communities.
This study investigated how it is working for adults with intellectual disability. It showed that it is a complicated process.
Some aspects of the National Disability Insurance Scheme are working well but there are missed opportunities.
There is a need to keep talking about how people think about disability so we can understand the impact different views have on the National Disability Insurance Scheme planning and outcomes for adults with intellectual disability.
In most disability insurance programs beneficiaries lose some or all of their benefits if they earn above an earnings threshold. While intended to screen out applicants with high remaining working ...capacity, earnings limits can also distort the labor supply of beneficiaries. We use a reduction in the earnings limit in Hungary to evaluate this trade-off and examine screening and labor supply responses. We find that the policy changed selection into the program modestly but reduced labor supply on the intensive margin significantly. These findings suggest that the earnings threshold should be higher.
•Earnings limits create a trade-off between their screening and distortionary effect.•We study a policy in Hungary that reduced the earnings limit for new DI beneficiaries.•Decrease in the earnings limit had a small impact on selection into the program.•The policy reduced labor supply on the intensive margin significantly.•Reduced labor supply is driven by beneficiaries with higher pre-disability earnings.
Opioid use is common among Social Security Disability Insurance (SSDI) beneficiaries, who account for a disproportionate share of opioid-related hospitalizations and mortality in the United States. ...However, little is known about the prevalence of opioid use prior to SSDI enrollment. Understanding when opioid use is established and how it correlates with individual characteristics and community prescribing practices would inform policy approaches to reducing opioid-related harm among SSDI beneficiaries. We estimated the prevalence of opioid use among SSDI applicants by applying a natural language processing algorithm to SSDI application data. We found the prevalence of opioid use among SSDI applicants declined from 33% in 2013 to 24% in 2018. In contrast, the share of applicants with musculoskeletal impairments, which are commonly associated with pain, was unchanged. The share of applications reporting opioid use declined across both sexes, all age groups and education levels, and all regions. There was substantial variation, however, in the magnitude of decline by geography, with the smallest declines in parts of the Midwest and Southeastern United States. SSDI application rates and applications reporting opioid use were more likely to come from communities with higher opioid prescribing rates. Our estimates suggest most SSDI beneficiaries began opioid use prior to entering the SSDI program.
Background
The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although ...the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families.
Method
A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis.
Results
The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families.
Conclusion
Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised.
We consider how work norms affect the likelihood of people receiving Social Security Disability Insurance (SSDI) in response to worsening economic conditions. By focusing on immigrants in the US, we ...can examine the influence of work norms in a person's home country, which we argue are exogenous to labor market prospects in the US. We find that the probability of receiving SSDI benefits is more sensitive to economic downturns among immigrants from countries where people place less importance on work. We also provide evidence that this result is not driven by differential labor market sensitivities to the business cycle or differences in other characteristics that might be correlated with norms.
Australians with a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan may at times require emergency care due to the fluctuating nature of their physical and mental ...health conditions or when their supports have become insufficient. This nationwide study investigated the experiences of people presenting to an emergency department (ED) who have a PSD and an NDIS plan. The objective was to understand current care and communication practices and to provide recommendations for service integration. Twenty‐four interviews were conducted with people who had a PSD and an NDIS plan. Participants were asked semi‐structured questions about their experiences when engaging with NDIS processes and when engaging with the ED as an NDIS recipient and how communication practices could be improved between the two services. A qualitative, descriptive thematic analysis approach was used. A lived experience advisory group participated in the research and provided commentary. The findings of this study indicate that the NDIS, as a personalised budget scheme, presents challenges for people with complex PSD and physical needs. ED clinicians appear to be unclear about what the NDIS provides and communication between the two systems is fragmented and inconsistent. The themes identified from the analysed transcripts are: (a) People with PSD experience distress when dealing with the NDIS; (b) There's a blame game between the ED and the NDIS; and (c) Inadequate service integration between the ED and NDIS. Recommendations to assist with service integration include building service capacity, providing overlapping care and bridging the diverse biomedical, psychosocial and disability care services.
Household Surveys in Crisis Meyer, Bruce D.; Mok, Wallace K. C.; Sullivan, James X.
The Journal of economic perspectives,
10/2015, Letnik:
29, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Household surveys, one of the main innovations in social science research of the last century, are threatened by declining accuracy due to reduced cooperation of respondents. While many indicators of ...survey quality have steadily declined in recent decades, the literature has largely emphasized rising nonresponse rates rather than other potentially more important dimensions to the problem. We divide the problem into rising rates of nonresponse, imputation, and measurement error, documenting the rise in each of these threats to survey quality over the past three decades. A fundamental problem in assessing biases due to these problems in surveys is the lack of a benchmark or measure of truth, leading us to focus on the accuracy of the reporting of government transfers. We provide evidence from aggregate measures of transfer reporting as well as linked microdata. We discuss the relative importance of misreporting of program receipt and conditional amounts of benefits received, as well as some of the conjectured reasons for declining cooperation and for survey errors. We end by discussing ways to reduce the impact of the problem including the increased use of administrative data and the possibilities for combining administrative and survey data.
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