The regional effect of the consumer directed care model for older people in Australia
| dc.contributor.author | Tran, My (Michelle) | en |
| dc.contributor.author | Gannon, Brenda | en |
| dc.date.accessioned | 2025-04-04T08:27:24Z | |
| dc.date.available | 2025-04-04T08:27:24Z | |
| dc.date.issued | 2021 | en |
| dc.description.abstract | Evaluation of Consumer Directed Care (CDC), an internationally recognized means to promote autonomy and choices in the delivery of health in community aged care, is growing, but little is known about the spatial implications of such policy. With differences in the utilisation of home care services across locations, the introduction of a national CDC program may affect different regions to different extents. This paper explores the regional effect of the CDC introduction on older Australians' mental health. We analyse data on 1780 individuals aged 65 years and over, from 11 waves (2007–2017) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We find that older adults’ mental health is worse after the introduction of the CDC in 2013. Moreover, older adults, who lived in the areas with higher utilisation of Home Care Packages, experienced worse mental stress than the same individuals who lived in the areas with lower utilisation of home care services. This pattern may reflect regional differences in Government funding, community aged care waiting time and provider service fees. Therefore, it is important for health policies that aim to promote choices to older consumers, such as CDC, to consider regional differences in its implementation, to minimise unwarranted variations in the population health and well-being. | en |
| dc.description.sponsorship | While the shift in power from the providers to consumers is just beginning in Australia, ‘cash for care’ schemes, another CDC model, have been operating in many countries including the UK, the US, Germany, Sweden, and France since the 1990s. International evidence around the benefits of these programs for older adults is mixed (Ottmann et al., 2013). Increasing choices has led to improved consumer satisfaction in the UK (Glendinning et al., 2008; Simon-Rusinowitz et al., 2005) and in the US (Mahoney et al., 2002). However, both the US and UK studies find that older consumers could experience negative psychological effects due to the additional burdens associated with planning and managing their supports ( Brown et al., 2007; Davey et al., 2007; Glendinning et al., 2008; Newbronner et al., 2011). Unlike in the US and UK where ‘cash for care’ is voluntary, the CDC model is mandated in Australia. Moreover, Australia only implemented a restrictive version of the CDC. Australian home care users have the right to choose the types of services and the delivery of the services. However, service providers are still responsible for financial accountability. In other words, consumers can choose their preferred care workers, but the hiring and assessment process must be done by the providers. Given these differences, it is important to evaluate the effect of CDC on health in the Australian community aged care setting.Whilse older Australians under the CDC model reported higher levels of control and independence (Bulamu et al., 2017), they have faced difficulties navigating the new system (Gill et al., 2018; Phillipson et al., 2019). Given the current trends in aged care services provision, that show an increase in preferences to “age at home”(Productivity Commission, 2008; Kaambwa et al., 2015) and the current situation of residential aged care, combined with the directions for older people to isolate, under the COVID-19 pandemic, it is important to quantify the effects of CDC on older Australians’ health, particularly mental health. This will provide us with vital information so we can better support older Australians to remain at home as long as they desire. Moreover, as the distribution of aged care services and funding varies considerably across regions, the introduction of the CDC may affect different regions to different extents.Over the 20 years between 1999 and 2019, the proportion of the Australian population aged 65 years and over increased from 12.3% to 15.9%. This number is expected to grow more rapidly over the next decade, as further cohorts of Baby Boomers (those born between the years 1946 and 1964) turn 65 (ABS, 2020). In 2019, 7% of those aged above 65 received residential care services, while 22% accessed some form of support or care at home (AIHW, 2019). These aged care services are funded by the Australian Government, non-government organizations and personal contributions from people receiving care. In 2018–19, governments spent over $20 billion on aged care, with the majority for residential aged care, followed by home care and support.Entry into aged care requires approval from the Aged Care Assessment Team (ACAT). The ACAT carries out assessments under the Federal Government's Aged Care Assessment programme (ACAP) to determine an individual's care needs, eligibility for services, recommendations for specific type of support needed and the level of aged care programme to be assigned. Most people, who are eligible for aged care services, are aged 65 years or older, or, 50 years or older if they identify as an Aboriginal or Torres Strait Islander person. Some younger persons with a disability, dementia and other care needs not met through other specialists services are also eligible for the services (Department of Health, 2020c).Currently, aged care services can be categorized into three major programs: residential aged care (RAC), home care and supports (HC) and transitional care (TC). The RAC program provides government subsidized institutional residential aged care services for those who are no longer fit to stay at home. HC have a focus on supporting people to remain at home for as long as possible, and thereby preventing premature or inappropriate admission into permanent RAC. Home care consumers can access subsidized services through the Commonwealth Home Support Program (CHSP) and the Home Care Packages Program (HCP). TC provides short-term care to older people leaving hospital or those who have accessed or who are deemed eligible for permanent RAC. Our paper focuses on home care programs, particularly Home Care Packages, that underwent major reform since 2012–2013. One of the primary changes is the Consumer Directed Care model in the HCP program which was first introduced across Australia on August 30, 2013.We find that services fees vary significantly across locations. Areas with relatively higher service fees tend to be remote areas with low numbers of service providers. A similar pattern emerges for administrative fees such as management fees and staff travelling fees, suggesting that the highest administrative fees are also in the remote areas that have lower numbers of providers. This pattern is consistent with the economic theory that in the areas with low numbers of providers, those providers have monopoly power and can set the price higher than the optimal price (Stole, 2007). Given these variations in funding, supply and fees, across regions, we expect a large shock in the home care market like the CDC, would potentially have differential effects across the regions. This type of effect is well noted in the literature in other contexts, for example, the effect of fiscal decentralization on regional disparities in health (Di Novi et al., 2019).Using the Queensland data extracted from the My Aged Care website, our study also provides some early evidence of regional differences in providers' service fees, which can also be a potential contribution to the differential effect of CDC across regions. However, further longitudinal research is needed to investigate the response of service providers to the Consumer Directed Care. An important future research question is whether increasing choices brought by the CDC model increase the competition among service providers and thus, reduce fees and improve the quality of care for these services; and whether these providers' behaviours affect HCPs recipients' well-being. Evaluations of the Consumer Directed Care model will ultimately help to reshape the aged care system, by assessing providers' behaviour and older people's well-being, and our paper provides first estimates from a large quantitative study. | en |
| dc.description.status | true | en |
| dc.identifier.other | researchoutputwizard:u6084937xPUB102 | en |
| dc.identifier.other | Scopus:85106937046 | en |
| dc.identifier.uri | https://dspace-test.anu.edu.au/handle/1885/733754721 | |
| dc.identifier.url | http://www.scopus.com/inward/record.url?scp=85106937046&partnerID=8YFLogxK | en |
| dc.language.iso | English | en |
| dc.rights | Publisher Copyright: © 2021 Elsevier Ltd | en |
| dc.source | Social Science and Medicine | en |
| dc.subject | Consumer directed care | en |
| dc.subject | Difference-in-difference | en |
| dc.subject | HILDA | en |
| dc.title | The regional effect of the consumer directed care model for older people in Australia | en |
| dc.type | Article | en |
| local.contributor.affiliation | Tran, My (Michelle); University of Queensland | en |
| local.contributor.affiliation | Gannon, Brenda; University of Queensland | en |
| local.identifier.citationvolume | 280 | en |
| local.identifier.doi | 10.1016/j.socscimed.2021.114017 | en |
| local.identifier.pure | 94577166-472e-4b2a-947a-243cd68dd91b | en |
| local.type.status | Published | en |