When Numbers Start Making Decisions · Season Four, “Things That Cannot Be Priced Directly” · Article 6
1. Cheaper is not necessarily better value
Imagine an NDIS participant requesting relatively expensive assistive technology. It could reduce paid support hours, lower fall risk and allow independent travel. A cheaper device performs some functions but leaves family members providing substantial help.
The National Disability Insurance Agency cannot ask only which item has the lowest purchase price. Each funded support must satisfy reasonable and necessary criteria, including that it relates to disability support needs, helps pursue goals and participation, is likely effective and beneficial, works appropriately with other supports and represents value for money. NDIS: What is reasonable and necessary
Value for money compares expected benefits with costs and considers alternative supports. It can include whether one support reduces the cost of other supports over time. There is no public rule that one additional unit of independence may cost no more than a fixed dollar amount.
The decision still becomes binary: the requested support is funded or it is not. Numbers about hours, prices, service life and alternatives are compressed into an eligibility judgement. Fairness depends on what counts as the same outcome and whose costs remain visible.
2. “Value” has at least four objects
First is value to the participant: communication, mobility, safety, relationships, choice and independence. Second is value to the NDIS budget: whether equivalent outcomes can be achieved at lower public cost and whether current support reduces future expenditure.
Third is value to family and carers: whether support prevents burnout, makes relationships sustainable and allows paid work or rest. Fourth is value to society: participation in education, employment and community life can produce benefits beyond the NDIS ledger.
These objects overlap but are not identical. A support can cost the Scheme more while reducing unpaid care and improving participation. A cheap option can transfer cost to a family. If the assessment examines only NDIA expenditure, it labels cost-shifting as efficiency.
The NDIS is an insurance scheme with social and economic participation goals, not merely a purchasing program. Value assessment should therefore connect price to the complete result the Act and rules seek.
3. Alternative supports require an outcome definition
Two supports are alternatives only if they achieve materially comparable outcomes for this participant. A basic wheelchair and a powered chair both provide mobility in an abstract sense, but not necessarily across the person’s home, terrain, fatigue, work and transport.
The decision-maker must first define the result: safe transfers, independent access, reduced support hours, communication or another goal. Price comparison without outcome equivalence is meaningless.
Evidence may include allied-health assessment, trials, supplier information, support-hour estimates and the participant’s experience. Uncertainty should be acknowledged. An innovative device may have less historical evidence while a familiar option has well-known limitations.
The cheapest option should not win by defining the desired outcome narrowly. Nor should the most expensive option win simply because it promises every benefit. The comparison needs explicit, participant-specific dimensions.
Outcome definition must also respect the participant’s own goals without assuming that every aspiration becomes an NDIS responsibility. Evidence can connect a support to functional and participation outcomes, while the funding criteria determine the Scheme’s role. Recording the expected outcome creates a later learning opportunity: did the device reduce falls, did communication improve, and was the support actually available? Without follow-up, “value” remains a forecast used only at the gate and never tested against lived results.
4. Family support is not priced at zero
NDIS decisions consider what it is reasonable to expect families, carers, informal networks and community services to provide. Informal support is central to many lives. It is not an unlimited free substitute for funded support.
Family care carries time, health, employment and relationship consequences. What is reasonable depends on the participant’s age, family circumstances, intensity and sustainability. Assuming that a parent or partner can continue because they have done so previously can turn exhaustion into the baseline.
The NDIS Review emphasised the need for a fair, sustainable scheme and better coordination across systems. NDIS Review: Working together to deliver the NDIS A complete value analysis should ask whether the alternative relies on unpaid care that is unsafe or unsustainable.
Recognising family cost does not require paying every act of ordinary relationship. It requires not treating constrained labour as economically and ethically invisible.
5. Short-term budgets and lifetime insurance
A lower-cost annual plan can create higher lifetime cost if it delays independence, causes injury or exhausts carers. Assistive technology may require substantial upfront spending and save support hours over several years. Early intervention can produce benefits outside the current plan period.
The opposite risk also exists. Forecast savings can be speculative, equipment may not be used, and circumstances can change. Decision-makers should state time horizon, expected service life, maintenance, residual value, probability of benefit and sensitivity to assumptions.
An insurance perspective supports investment where credible long-term benefit exists. It does not authorise vague claims that every expensive support “pays for itself”. Evidence and review should match the uncertainty.
6. Price limits are not the value judgement
The NDIS pricing arrangements set or guide maximum prices for many supports. They consider provider costs and workforce sustainability. The 2026 pricing schedule took effect on 1 July 2026. A price limit does not prove that a support is reasonable and necessary for an individual, and paying below the limit does not prove value.
Conversely, an unavailable service at the capped price may not be a real alternative in a remote area. Market thinness, travel and specialised skill affect deliverability. A paper comparison with a service the participant cannot obtain is not a valid value-for-money assessment.
7. Explanation and review must be able to change the plan
Participants should receive reasons identifying the requested support, evidence, relevant criteria, alternatives and cost-benefit logic. A generic statement that an item is “not value for money” does not allow correction or meaningful review.
NDIS decisions can be internally reviewed if requested within the applicable period, and an internal review decision can be taken to the Administrative Review Tribunal. Current NDIS guidance says a person generally has three months from receiving the written decision to request internal review. NDIS: What is a decision review
Review should be able to consider new evidence and the participant’s circumstances, not merely confirm that a template was used. Patterns in overturned decisions should improve future guidance.
8. Need exists in the relationship between person and environment
Disability support need is not a shopping list located solely inside a body. Stairs, inaccessible transport, communication systems, assistance and social expectations create or reduce barriers. A support changes that relationship.
Value for money should therefore examine achieved capability, not just purchased units. Two hours of support and one device cannot be compared by price until the person’s environment and desired result are understood.
9. A practical test for NDIS value
Ask:
- What participant outcome is being valued?
- Are alternatives genuinely equivalent and available?
- Which costs fall on the NDIA, family and other systems?
- Is informal support reasonable and sustainable?
- What time horizon and evidence support predicted savings?
- Are risk, maintenance and non-use considered?
- Do reasons identify the decisive comparison?
- Can review change the support and feed learning back into guidance?
Conclusion: compare complete outcomes, not only the NDIA invoice
Value for money is necessary in a publicly funded insurance scheme. Ignoring cost would allow finite resources to be exhausted, while choosing the cheapest item would often fail the participant and create larger costs elsewhere.
My judgement is that the NDIS should compare participant-specific, deliverable outcomes across a credible time horizon and make unpaid family cost visible. Price limits and alternative quotes are inputs, not the final value judgement.
The value of a support lies in the capability and sustainable relationships it enables—not merely in how little the agency pays today.
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