title: Fixing the system? The experience of service users of the quasi-market in disability services in Australia.
abstract: A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.
authors.affiliation: PO Box 80, Wilston, Queensland, Australia.
authors.forename: Pam
authors.initials: P
authors.lastname: Spall
authors.forename: Catherine
authors.initials: C
authors.lastname: McDonald
authors.forename: Di
authors.initials: D
authors.lastname: Zetlin
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D003284:Contract Services / Q000592:standards*; D003659:Decision Making, Organizational; D006233:Persons with Disabilities; D018166:Health Care Reform; D006801:Humans; D007407:Interviews as Topic; D010548:Personal Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D011793:Queensland; D019035:Rural Health Services / Q000592:standards; D012944:Social Support; D012946:Social Welfare; D019037:Urban Health Services / Q000592:standards