Research: Implementation of the NDIS in Rural, Regional and Remote Australia
A deep dive into how the NDIS has been implemented across Australia, with some significant shortfalls for participants living in Remote areas.
A recent editorial, "Implementation of the NDIS in Rural, Regional and Remote Areas," published in the Australian Journal of Rural Health (2025) by Pim Kuipers and Jo Spong1, compiles insights from recent articles to examine the National Disability Insurance Scheme's (NDIS) rollout in non-urban Australia.
Drawing on a virtual issue of the journal2, the authors highlight systemic burdens, workforce constraints, and resulting complexities that hinder equitable access for people with disabilities, while acknowledging some benefits and proposing strategies for improvement.
Despite criticisms, the NDIS has delivered notable benefits for many rural and regional individuals with disabilities and their families. New services have emerged in underserved areas, offering greater choice in services, and social participation has increased. Family members report enhanced workforce involvement, increased leisure time, reduced financial stress, and optimism about the future.
However, these gains are inconsistent; some recipients experience minimal benefits amid significant hardships, underscoring disparities in rural contexts. Below are the main “Burdens of Treatment” that the researchers found.
Disclaimer: All quotes below have been pulled directly from the editorial. Insight PBS takes no credit for the below text. Please refer to the full text if you’d like to learn more about the topic3
Burdens of Treatment
System-Related Burden
Some rural people with disabilities and families have described their dealing with the NDIS system as battling a bureaucracy. The complexity of the system is a major obstacle, and for rural and remote people, their experience is of a system that has lost touch with its core values.
Burden of Disease
Insufficient funding for travel, to compensate for rural and remote communities is a key part of the negative experience of rural people with disabilities and their families. If they are awarded funding but there are no local or other available services, they perceive the NDIS aspirations of ‘choice and control’ as meaningless.
Access Burdens
Limited access to NDIS-related and professional services is a key theme for rural people with disabilities and their families. The NDIS has not consistently improved access for all rural people with disabilities, leading to frustration in some small communities where substantial disparity or inequity of access becomes evident. Access burdens are also exacerbated when NDIS personnel have limited knowledge about disability, disability services and regional/remote realities.
Family Member Burdens
The lived experience of family members within the NDIS sphere has not been positive. For some, meaningful benefit can only be gained from the NDIS if they take an active and ongoing involvement, provide advocacy and at times even fulfil some functions of NDIS staff. Such reliance on families perpetuates inequity. Family members described feeling overwhelmed by the complexity of the system. Coordinating across scarcity is very difficult. Limited supports, limited choice and availability, delays, isolation and uncertainty of access mean that confusion and frustration are common. This results in a great emotional burden and mental health consequences for family members.
NDIS-Worker Capacity Limitations
Personnel-Related
Rural people's experience of dealing with NDIS personnel was described as predominantly negative and burdensome, leading to greater strain. Whether due to limited skills or lack of understanding of the challenges of distance and rurality, the result was often unrealistic with insufficient plans and expectations. NDIS personnel and systems have been seen as lacking flexibility and compassion, with inconsistent and poor communication.
Skills-Related
Implementation of the NDIS in rural communities will impact on the local skills base. While many rural disability-related staff, providers and other workers recognise that it is their role to provide quality support for people with disability, inexperienced staff may not know how to provide the support that is necessary. Regional staff often want to enhance their knowledge reporting insufficient undergraduate education and limited professional development; however, there are barriers to upskilling.
Cultural Safety
Recent literature has found NDIS workers to lack cultural competence and cultural safety, and as a result, NDIS services have fallen short of meeting the needs of Aboriginal people with disabilities.
Workforce Isolation
Disability service providers and workers in rural and regional areas often work in isolation with little supervision or support from those with expertise. Professional isolation is recognised as a possible predictor of burnout. These issues must be considered in the development of rural NDIS service responses.
Workforce Time Constraints
Time pressures on disability workers and providers also hinder their ability to develop a deep understanding of the person's needs. In contrast, when there is sufficient time and engagement between workers and the person with disability and their family, it is easier to complete tasks and provide comprehensive support.
Recruitment
The shortage of existing healthcare workers (and potential candidates) in rural locations has broader consequences. It has constrained the capacity of NDIS services to adequately address the complex realities faced by people with disabilities.
Retention
Staff turnover and limited retention of rural workers with experience of NDIS processes and planning is common in remote areas.. In some instances, this might be related to poor remuneration which has been found to be a possible predictor of burnout along with the stresses of rural work.
All of these factors culminate in "cumulative complexity," where treatment burdens and capacity shortfalls profoundly affect individuals, families, and communities, aligning with models like Minimally Disruptive Medicine.
To mitigate this, the authors advocate strategies such as
prioritising rural access through co-design
fostering interdisciplinary collaboration
sharing staff and information
inter-professional training
enhancing cultural safety
boosting recruitment incentives
supporting non-medical workers
reorienting services for flexibility.
Returning to NDIS first principles: ensuring inclusion, safety, and support—could rebuild trust.
Better guidance for navigation would empower users.
Overall, the editorial advocates for systemic reforms to reduce undue complexity, emphasising that while the NDIS holds promise, its rural implementation necessitates tailored approaches to achieve equity. By addressing these issues, the scheme can better fulfil its goals for Australia's diverse geographies.
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Kuipers, P., & Spong, J. (2025). Implementation of the NDIS in Rural, Regional and Remote Areas. The Australian Journal of Rural Health, 33(2), e70046-n/a. https://doi.org/10.1111/ajr.70046
https://browzine.com/libraries/2177/journals/2614/issues/603868381
Kuipers, P., & Spong, J. (2025). Implementation of the NDIS in Rural, Regional and Remote Areas. The Australian Journal of Rural Health, 33(2), e70046-n/a. https://doi.org/10.1111/ajr.70046