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Care systems worldwide regularly undergo reforms and adjustments in the hope of system improvements. In many ways this can align with calls for governments to be more 'adaptive' and 'agile' to changing care demands. However, such continued adaptations can create turbulence for the care sectors in question. In this article, we examine the large-scale reform of the Australia National Disability Insurance Scheme and the impact of a series of adaptations on the disability care sector in Australia. We find that the disability sector in Australia is experiencing turbulence and a lack of clarity about the rules regarding the programme, resulting in increased administrative burden and financial pressures. Such turbulence has flow-on effects on the level of care that is able to be accessed by people with disability in Australia.

BACKGROUND: Researchers and policymakers are increasingly concerned that personalisation schemes in social and health care might be worsening social and health inequities. This has been found internationally, where better outcomes from such schemes have been found amongst those who have higher education and more household income. METHOD: This study looks at one of the world's largest personalisation schemes, the Australian National Disability Insurance Scheme. Using publicly available data we examine the allocation and utilisation of NDIS funds according to social gradient. RESULTS: We find that the rate at which people with disability 'spend' or effectively use their disability care funds follows a social gradient. That is, those in areas of higher socioeconomic disadvantage are not spending as much of their allocated budgets on care services across the year compared to people in areas of higher socioeconomic advantage. This represents a clear issue of equity in the use of public money to people with disability in Australia. CONCLUSION: We argue that this points to the need to provide targeted supports for the use of disability care funds in areas of higher socioeconomic disadvantage. Without effective supports for fund use, the NDIS and other personalisation schemes may be positioned to worsen existing social inequalities.

Markets are increasingly used by governments to deliver social services, underpinned by the belief that they can drive efficiency and quality. These ‘quasi‐markets' require on‐going management to ensure they meet policy goals, and address issues of market inequity. This has seen debates emerge around ‘market stewardship' and ‘market shaping’ that center on how best to manage markets toward optimal policy outcomes. At present, there is a significant gap in both literature and practice with regard to what types of actions are most effective for market stewardship. In this article, we outline a framework that helps diagnose different quasi‐market problems. We delineate two dimensions of public service quasi‐markets—sufficiency and diversity—using the example of a disability personalization market to show how this framework can unpack different types of quasi‐market states. Lastly, we outline the types of interventions that might be adopted to help deal with ineffective quasi‐markets. Evidence for Practice Market mechanisms are increasing being used by governments around the world to drive innovation and efficacies. Increasingly it is being recognized that these markets need intervention in order to meet policy goals. This paper provides a framework for conceptualizing types of market problems, and offers solutions for the scenarios outlined.

The Australian Productivity Commission (PC) is an inquiry body of international renown, which Australian governments engage to obtain objective evidence‐informed recommendations regarding a wide range of policy issues. Despite its prominence in the Australian policy landscape, there has been little empirical investigation into its practices. This study sought to understand the processes by which evidence is produced and communicated by the PC, with an emphasis on understanding its role within the policy process. Our findings unsettle the notion of the PC as an arms‐length, independent body from government – revealing a more complex interplay of interpersonal strategies in both the production of evidence, shaping of recommendations, and communication of both. We identify practices undertaken by PC staff commonly attributed to policy entrepreneurs – or individuals seeking to influence policy and political processes. Our findings suggest that in different contexts and at different times, the PC shifts between being an apolitical or political actor.

Previous research has indicated that administrative burdens are particularly high in personalised funding schemes such as the Australian National Disability Insurance Scheme (NDIS), because these schemes are predicated on very high levels of self-advocacy. Administrative burdens tend to be inequitably distributed, thereby entrenching existing social inequalities. This is the first study to look at the lived experiences of administrative burden within the NDIS explicitly-and particularly those of women, who are underrepresented within the scheme. The research involved qualitative interviews with 30 women with disability who were either NDIS participants or had considered applying for the NDIS. We argue that like other marginalised groups, women with disability are experiencing significant administrative burdens within the NDIS, which are barriers to obtaining sufficient disability support. Based on this finding, we recommend the NDIS implement a gender strategy, as well as address burdensome administrative processes in general.