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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