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      Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme

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          Abstract

          Background

          Increasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature.

          There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation.

          Methods

          As part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity.

          Results and discussion

          Scheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities.

          Conclusions

          The research concluded that ‘personalisation’ approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages.

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          Most cited references63

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          World report on disability.

          (2011)
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            Effects of daily hassles and eating style on eating behavior.

            This study investigated the daily hassles-eating behavior relationship and its moderators in a naturalistic setting. A multilevel diary design was used to examine day-to-day within-person effects of daily hassles on eating behavior (N = 422), together with the individual and simultaneous influence of potential moderating variables. Daily diary reports of between-meal snacking, fruit and vegetable consumption and perceived variations in daily food intake. The results showed daily hassles were associated with increased consumption of high fat/sugar snacks and with a reduction in main meals and vegetable consumption. Ego-threatening, interpersonal and work-related hassles were associated with increased snacking, whereas, physical stressors were associated with decreased snacking. The overall hassles-snacking relationship was significantly stronger and more positive at high compared to low levels of restraint, emotional eating, disinhibition, external eating and in females and obese participants. Simultaneous consideration of these moderators indicated that emotional eating was the pre-eminent moderator of the hassles-snacking relationship. Daily hassles were associated with an increase in unhealthy eating behavior. These changes may indicate an important indirect pathway through which stress influences health risk. (Copyright) 2008 APA.
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              Quasi-Markets and Social Policy

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                Author and article information

                Contributors
                G.carey@adfa.edu.au
                e.malbon@adfa.edu.au
                d.reeders@adfa.edu.au
                a.kavanagh@unimelb.edu.au
                g.llewllyn@sydney.edu.au
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                6 November 2017
                6 November 2017
                2017
                : 16
                : 192
                Affiliations
                [1 ]Centre for Public Service Research, UNSW Canberra, Canberra, Australia
                [2 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, School of Population Health, , University of Melbourne, ; Melbourne, Australia
                [3 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Centre for Disability Research and Policy, , University of Sydney, ; Sydney, Australia
                Article
                682
                10.1186/s12939-017-0682-z
                5674687
                29110663
                869a4bde-b2cb-473b-b792-1dd44483e7d1
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 July 2017
                : 9 October 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: CRE Disability and Health
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                Health & Social care

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