industry & policy
Hazards ahead for CDC
We’ ve got the roadmap now. Does anyone know where we are going?
By Michael Fine
There is no need to tell readers of Insite that the aged-care service system in Australia is currently in a state of flux.
That’ s not new, of course, nor unique to aged care. In the 21st century, change has become so commonplace that it has become a cliché to observe that the only thing that stays the same is constant change.
But February 27, 2017, marked a special date in our ageing history. That’ s when the funding system changed in the home care sector to consumer directed care, or CDC.
This is planned to spread – first to the Commonwealth Home Support Programme( CHSP). Can you imagine it applying to residential care services in the next few years?
For consumers, the benefits of CDC are identified as‘ choice’. Choice of provider, followed by more choice, as the consumer chooses how to spend the funds on what he or she would like. And if the provider doesn’ t like it, or can’ t arrange it to the satisfaction of the consumer, then the consumer can change to another provider. At least that’ s the theory, or should I say, the sales pitch. Lots of things can and often do go wrong with new schemes. Not least will be the one when the consumer makes uninformed or incorrect decisions or perhaps no decision at all. And who is the consumer anyway? Family members or other unpaid carers should properly be considered consumers, but will they be? What happens when they disagree with the service recipient?
And will changing service providers turn out to be simple? I met someone this week who told me she had been trying to find out how to go about it, and it seems to be anything but easy. The only clear message she could get was that it would be a huge task, requiring massive work.
And how will it work out for service providers? Clearly there has been a lot of preparation for the change. In most areas, advertising to attract new consumers has already commenced. This is an unprecedented event in this field, but one that we will all have to pay for some way or another.
Regardless of whether services are non-profit or private for-profit, all providers will be increasingly required to operate in competitive ways through changes to the payment and funding system.
The choices made by consumers are claimed to operate in a way that will enable the development of what is in effect a selfregulating market. Instead of planning where services will be made available, the market will now do that.
But what if all existing packages are occupied, and if one or two service providers come to dominate provision in your region? Markets typically operate so that some areas are well catered for while others are poorly serviced. Can we be sure that it won’ t happen in aged care?
For many years we’ ve been told that other countries have already gone down this path and that Australia is lagging behind. We can indeed learn from these examples. Last month, the UK media was up in arms – one of the major dailies, for example, reported that the English social care system for the elderly was facing“ complete collapse”. Across the Channel, in the Netherlands, politicians have now realised that market systems increase demand and that this leads to rising costs, not reduced expenditures.
We’ ve got the road map, alright. But where is it taking us? Fasten your seatbelts! ■
Michael Fine is an adjunct professor at Macquarie University.
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