How Hard is Fair?

Australian Compensation
Health Research Forum
October 13/14, 2011

Chris Latham

Overview
The need to measure
What should we measure?
Why is impairment favoured?
Can we do better?
International Classification of Functioning etc (ICF)
Measurement tools in NDIS context
Where to from here?

The need to measure

Accident compensation schemes can be:

No-fault
Fault-based (common law)
A hybrid

In each case a measure of severity is used to determine

eligibility and/or quantum

Eligibility-thresholds for lump sums, income benefits

Quantum-can be explicit or implicit

Proportions of benefits affected can vary widely

What should we measure?

Impairment or disability

Fundamentally different approaches which derive from

alternative models
Impairment

Disability

Model
Characteristic

Medical model
Social model
A deficiency relative to A difference
the norm
Internal/external Internal
External
Remedy

Cure/normalisation of
the individual
Agent of remedy The professional

Change in interaction with

society
Anyone who can affect
relationship with society

Existing confusion
4

Why is impairment favoured?

In Australia and NZ impairment reigns supreme because:

There are respectable tools available (AMA Guides)

Seen as objective, have credibility

Have been successful in keeping costs stable

Is this good enough?

Can we do better?

Use of impairment fails to distinguish individual

circumstances

Common law does this-but suffers from other problems

The social model is more compelling

Need for a measure of disability for a no-fault environment

ICF

Provides a framework for measuring disability

Endorsed by WHO

Australian User Guide prepared by AIHW in 2003

Need to move from framework to development of

assessment tools

Measurement tools in NDIS context

NDIS requires assessment of support needs

Acknowledged that no perfect tools currently available

Existing tools specific to certain disabilities- not applicable

generally

Need for coherent package of tools while encouraging ongoing development

Where to from here?

A change from impairment to disability in accident

compensation would be difficult

Time-consuming, expensive, dislocation in schemes

But- if it is the right thing to do we should do it

Remember the words of Jean-Paul Sartre

 2010 PricewaterhouseCoopers. All rights reserved. In this document, PwC refers

to PricewaterhouseCoopers, which is a member firm of PricewaterhouseCoopers
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