Is the delivery of National Disability Insurance Scheme in Australia through quasi markets achieving the right outcomes in vision rehabilitation services? A qualitative study.

Purpose: Despite being a pioneering social initiative worldwide, Australia's National Disability Insurance Scheme (NDIS) still presents unresolved issues for individuals with vision-related disability regarding its processes and outcomes. This study evaluates how well the NDIS markets are perceived to achieve efficiency, responsiveness, choice, quality, and equity within the vision rehabilitation sector, and identified factors facilitating or hindering desired outcomes.

Materials and methods: This qualitative study conducted 22 semi-structured interviews involving individuals with vision disability, service providers, peak-body and professional-body representatives, and an NDIS planner.

Results: Findings across stakeholder groups show minimal variation. The NDIS's quasi-market approach has improved participants' choices over ways to utilise and manage their funding and consequently provided them with a sense of control and empowerment. However, inefficiencies persist due to insufficient competition, workforce shortages, price caps, information asymmetry, high transaction costs, gaming behaviour, inadequate staff training, complex and lengthy processes, and eligibility concerns. Supportive factors include effective advocacy, pragmatic regulations to maintain quality, opportunities for innovation, and service providers' motivation for cost-effectiveness.

Conclusions: While NDIS markets have made significant strides in enhancing participants' choice and control, our findings underscore the need for continued refinement to achieve broader social objectives and long-term sustainability for individuals with vision-related disability.