Human Services Goods in the Australian Aged Care and Disability Sector

In economic policy and analysis we refer to the substance of all transactions as goods. Human service goods provision in the Australian aged care and disability sectors (ACDS) is failing. Two recent Royal Commissions have exposed significant and substantial institutional governance issues in delivering quality and timely services, free from neglect and abuse. ACDS human services providers (largely non-profits) are suffering substantial financial and workforce sustainability stress (Carey et al., 2020; Gilchrist & Emery, 2020; Stewart Brown Advisory, 2020), with commensurate significant levels of under-utilisation (Gilchrist et al., 2020 ; National Disability Services, 2019; Royal Commission into Aged Care Quality and Safety, 2021).
Human service goods are diverse, often complex, personalised, and needed for everyday living. Their range includes, but is not limited to, cleaning, nutrition, personal hygiene assistance, social, emotional and physical support, specialist therapies and nursing care, assistance with dementia, vision, hearing, speech and mental illness, and customised equipment and accommodation.
Care and support for vulnerable individuals remains a vexed issue for largely charitable human services providers and governments. New Public Management reforms of the 1980’s and 1990’s introduced the rhetoric of market economics in governance arrangements. As happened in many developed countries, concepts such as competition, contractualism and outsourcing, intended to encourage efficiency, responsiveness, innovation, and consumer choice, were embraced (Gilchrist, 2020; Lapuente & Van de Walle, 2020) by Australian governments. This is reflected in the adoption of ‘faux’ or ‘quasi-market’ funding structures in ACDS that emphasise a rhetoric of consumer sovereignty, such as “choice and control” (Department of Social Services, 2018) and “Consumer Directed Care” (Grove, 2016), whilst actually operating as financial resource rationing systems.
A fundamental issue impacting the effectiveness of these rhetorical devices is a lack of understanding as to the type of economic goods ACDS human services actually are, or the importance of this aspect. Sound public policy and practice relies on market and non-market goods classifications, involving interpretations and assumptions relating to the behaviour of actors in relation to consumption and provision. If the good is not classified appropriately, the assumptions and prescriptions can be wrong and detrimental to sustainability of service delivery.
Questions asked in this research include: What assumptions are being made about consumption, provision, and expectations of participant behaviour of these human service goods in funding policy? Do ACDS human service goods have attributes that make it impossible to emulate market goods and make it difficult for consumers and service providers to respond as if in a true market?
To explore the understanding and application of market economics and market goods in public discourse and policy, a case study on the popularisation of a human service market will be conducted using media reports following the release of the 2011 Productivity Commission on Disability Care and Support Inquiry Report and the resultant NDIS framework. This will be followed by a qualitative thematic analysis of semi-structured interviews with ACDS market participants (consumers and service providers) to identify any gaps between intended and actual behaviour of market players, and any service characteristics that may account for discrepancy. Exploring how market theory and ACDS human services goods are understood and experienced will contribute to future development of human sector service delivery to our most vulnerable in Australia.