(This article originally published in NCOSS News October 2008)

by Kristie Brown
NCOSS believes that PADP is a fundamental part of the NSW Government’s responsibility to support and promote the engagement of people with disability in all aspects of society. The PADP program provides equipment, aids and appliances to people with a life-long or long-term disability in order to support them to live independently in the community. When meeting its objectives, PADP can be considered an essential foundational element upon which the Government’s commitment to people with disability can be based.

1. Funding allocations to PADP are inadequate, preventing the program from meeting either current or projected demand;
2. Eligibility requirements do not take proper account of equity considerations, and fail to recognise the high cost of living faced by people with disability or that people with disability are proportionately over-represented within low income categories; and
3. Co-payments associated with PADP cause unnecessary, and at times significant, financial hardship.

Adequacy of funding for present and projected program demand
The resourcing and administration of PADP is an ongoing problem for consumers seeking equipment to assist them to live in the community. The program is significantly under-resourced. Long waiting lists remain a major concern, with many consumers lacking basic equipment to assist with mobility or other impairments.

A report released in 2006 by PricewaterhouseCoopers found that there was a “failure of the available funds to adequately satisfy the reasonable expectation of the client group”. ¹ The report also concluded that demand on PADP would continue to increase with estimated increases in population prevalence of disability.

Whilst there has been some additional investment in PADP following on from this report, including $11m in July 2008 to reduce the waiting list, there has been no substantial change to core or ongoing funding for the program, leaving issues such as unmet and increasing demand, long waiting lists and under-investment in the program largely unresolved beyond the short term.
Impact of client waiting lists on other health sectors

Affordable access to equipment is a key strategy to reduce hardship and promote community participation for people with disability and their families. The supply of essential equipment can promote independence and reduce the need for admission to intensive forms of care such as residential institutions. Appropriate equipment can help people to avoid future hospital admission (for example through falls prevention) and facilitate in home community care provision. As such, PADP is an integral part of the network of services that allows individuals to leave hospital under earlier discharge strategies and to live in the community rather than in residential facilities.

NCOSS believes that some of the pressure currently exerted on acute care services within the public health system is the result of a lack of investment in public health services, in particular health promotion and early intervention and prevention services, including programs like PADP. Whilst it is difficult to identify data that specifically implicates any direct inadequacy for PADP in preventable interactions with acute care services, there is a range of general research available which supports this position.^2,3 

Appropriateness and equity of eligibility requirements
Many people with disability experience substantially higher costs of living in comparison to other members of the community.⁴ The 2004 Senate Community Affairs Committee Inquiry found that there were a large number of factors that led to these costs:

In addition to being excluded from earning an adequate income, people with disabilities often have higher costs of living associated with their disability. This may include the high cost of medication, the purchase of special equipment or aids, and access to appropriate housing, transport and services related to personal care or maintenance of a person’s home. The combination of higher costs of living, along with low income, leads to a strong connection between disability and poverty.⁵

Many low income people with a disability already devote a large proportion of their weekly income to meet the costs of having a disability, with the Social Policy Research Centre finding the average cost of disability are estimated at about 29% of equivalised household income, rising to between 40 to 49% for those with severe or profound restriction.⁶

Given that we know that the vast majority of people with disability are likely to come from a low income household, and that the high costs of disability will adversely impact on a range of households, even those higher up the income scale, NCOSS believes that PADP should be an entitlement for all people with disability, and that exclusions should only apply to very high income earners. NCOSS believes that the implementation of ‘eligibility bands’ for PADP are driven by inadequate allocation of resources by Government rather than equity concerns per se.

Copayments
Co-Payments can pose a financial barrier for some low income earners. NCOSS notes that PADP applicants who rely solely on pension income may experience hardship in raising the annual $100 co-payment required to participate in the program. Co-Payments disadvantage those who are least able to afford healthcare:

Co-payments can be considered inequitable in that they impose barriers to the use of medical service with potentially negative health consequences for an already disadvantaged group. This is inconsistent with the move towards concerns with health outcomes as measures of health system performance and the goal of reducing differences in health status across social groups.⁷

People with disability and people from low socioeconomic groups already experience more difficulty accessing health services,⁸ have lower life expectancy⁹  and experience poorer health across a range of areas.¹⁰

As such, NCOSS believes that co-payments exacerbate health inequalities between those most and least able to afford healthcare. As such, NCOSS supports the removal of co-payments from the program, in recognition that people with a life-long or long-term disability face considerable additional costs associated with that disability and that copayments are inequitable.

Recommendations
Based on these concerns, NCOSS made the following recommendations:

1. That funding for PADP be increased by an additional $24.4m in 2009-10, rising to a total budget of $100m in 2014-15;¹¹
2. That income-based eligibility criteria for PADP is removed, and that any exclusions only apply to very high income earners.
3. That co-payments for PADP are removed.

NCOSS believes that if properly resourced the PADP program will assist the Government to meet a number of the commitments set out in the State Plan: A new direction for NSW. In particular, a properly resourced PADP program will assist the NSW Government to meet commitments in relation to Increased employment and community participation for people with disabilities and Reduced avoidable hospital admission.

Endnotes
¹ PricewaterhouseCoopers, Review of the program of appliances for disabled people, June 2006
² NSW Health 2006, The health of the people of New South Wales: Report of the Chief Health Officer, Sydney: NSW Department of Health p.85
³ Page A, Ambrose S, Glover J, Hetzel D. 2007, Atlas of Avoidable Hospitalisations in Australia: ambulatory care-sensitive conditions, Adelaide: University of Adelaide. Available at: www.publichealth.gov.au/pdf/atlases/avoid_hosp_aust_2007/avoid_hosp_full.pdf, viewed 19 March 2008.
⁴ See Peter Saunders, “Disability, Poverty and Living Standards: Reviewing Australian Evidence and Policies,” Discussion Paper 145, Social Policy Research Centre, 2005; and Physical Disability Council of Australia, “ Towards a Disability Allowance: Offsetting the Costs of Disability”, 2001.
⁵ Senate Community Affairs Committee, A Hand Up not a Hand Out: Renewing the Fight Against Poverty. Report on Poverty and Financial Hardship. March 2004, p363.
⁶ Peter Saunders, “Disability, Poverty and Living Standards: Reviewing Australian Evidence and Policies,” Discussion Paper 145, Social Policy Research Centre, 2005
⁷ Jane Hall, Centre for Health Economics, Research and Evaluation, “Are co-payments a public health issue?”, Public Health Bulletin, December 1991: v.2
⁸ NSW Health, NSW Population health survey: 2006 Report on Adult Health in NSW, 2007
⁹ Report of the NSW Chief Health Officer, “Socioeconomic status and life expectancy”.
¹⁰ Australian Institute of Health and Welfare, Australia’s Health 2008, 2008
¹¹  Based on figures calculated by PricewaterhouseCoopers, Review of the program of appliances for disabled people, June 2006.