Market Stewardship in the National Disability Insurance Scheme: The role of non-government actors

Abstract

As market-based responses to social care have grown in popularity across the world, the need for good market stewardship of social care quasi-markets is increasingly becoming a concern for governments. Across the world, the use of ‘quasi-markets’, where services are provided by competitive providers but purchasers of services are funded by the state, have gained in popularity as way to deliver social care. This has presented considerable challenges regarding governance of these markets, and how to ensure they meet their policy goals. In a marketised care system the market must be stewarded to meet the underlying social and health needs that it is set up to facilitate, as opposed to allowing markets to operate freely and unregulated. To date, both scholarship and practice on quasi-market stewardship has focused almost exclusively on the role of government, with a lack of attention on the stewardship role of other non-government actors in the system. This thesis helps fill this research gap by examining the market stewardship role of non-government actors in a large social care quasi-market - the Australian National Disability Insurance Scheme (NDIS). Findings show a wide range of non-government actors are conducting both direct and indirect stewardship actions that are actively shaping the NDIS market. These include activities focused on both the participant (or consumer) side of the market such as advocacy and information provision and on the provider (or supply) side such as connecting consumers with services, assisting providers with regulatory and administrative requirements and marketing for providers. This thesis argues that while there remains important stewardship roles for central government, findings suggest stewardship in the NDIS is a distributed activity across a range of both government and non-government actors. This type of ‘distributed stewardship’ is not necessarily problematic as long as it is recognised, planned for, and supported. However, distributed stewardship requires ‘joined-up’ working between government and non-government actors. Based on theories and models from the joined-up government literature this thesis proposes development of a preliminary framework or supportive architecture for distributed stewardship in the NDIS, to enable more effective market stewardship