The expensive business of making Australians wait for help

Delaying aged care, disability support and other public services may contain spending in one part of government, but the costs don’t disappear. They move to families, hospitals, review systems and the people left waiting for help.

Governments ration services because they have to, and economists have given us a raft of euphemistic terms to make that sound both respectable and inevitable: allocative efficiency, opportunity cost, resource constraints, fiscal sustainability and, when all else fails, the marginal benefit of spending the next dollar somewhere else.

What we are much less inclined to talk about is the extraordinarily expensive machinery required to stop that next dollar being spent on you.

In Australia we ration health, aged care, disability support and help at home in many ways, but one of the most effective is time, because if the government does not actually refuse a service but instead makes you wait for it, the expenditure can be postponed while the person remains notionally entitled to something they may or may not receive before circumstances overtake them.

The Productivity Commission tells us that in 2024–25 the median wait from approval to commencement of a Home Care Package was 245 days, while somebody at the 90th percentile waited 366 days, which means that after an older Australian has established that they need support to remain at home, we have developed a system capable of taking the better part of a year to provide it.

There are, of course, perfectly good reasons why government needs eligibility criteria, assessments and safeguards, and nobody sensible is arguing that anyone who rings Canberra should be immediately dispatched a taxpayer-funded shower attendant. But there is a point where managing scarce resources becomes an industry in managing access to scarce resources.

That distinction is important because the person who is waiting does not simply sit politely in a chair for 245 days until somebody appears.

They or their carer have to find out what is happening, whether the assessment has been completed, whether another form is required, whether their circumstances have changed enough to require another assessment and why the answer they have just received bears no apparent relationship to the answer they were given last month.

That is the part of rationing we rarely put into the economic calculation.

We know how much a service costs to provide, but we are considerably less interested in how much it costs to make somebody wait for it.

There is the assessment, the reassessment, the administration required to maintain the queue, the internal review when somebody disputes a decision and, if the disagreement continues, another layer of review beyond the agency itself.

Nobody would seriously suggest abolishing merits review merely because it costs money. The right to challenge government decisions is one of the protections citizens should have against government power. However, there is a legitimate economic question about how much public money we spend making a decision, defending the decision, reviewing the decision and sometimes changing the decision, compared with what was saved by denying or delaying the service in the first place.

None of this administration is free, and neither is the time people spend trying to negotiate it.

The telephone provides a particularly neat example because it is where public policy and human endurance occasionally meet.

The Australian National Audit Office found that over the three years to June 2024, the average daily wait on the Older Australians phone line was below 15 minutes on only 9.35 per cent of operating days, while on 57.31 per cent of days the maximum wait exceeded an hour.

An older person could therefore be waiting months for the service and spend a respectable portion of an afternoon trying to find out why they were still waiting for it. That presumably counts as efficiency somewhere, although it is difficult to imagine where.

There is some encouraging evidence about what happens when governments stop assuming that efficiency means having fewer people available to deal with the public, because Services Australia says that additional government resourcing helped it answer its 44.3 million telephone calls in 2024–25 on average 22 per cent faster than the year before, while it also provided 1.6 million place-in-queue callbacks.

That should tell us something fairly obvious that, nevertheless, seems to require periodic rediscovery in public administration. Employing enough properly trained people to resolve a problem the first time can be more efficient than employing too few people to explain repeatedly why nobody can resolve it.

Cutting a public servant does not make the work disappear any more than delaying a shower makes the need for one disappear.

The work moves.

A problem that is not resolved at the front of the system can become a review, a complaint, an approach to an MP, an ombudsman matter or somebody else’s administrative problem. All the while an APS5 officer can be left trying to explain to an increasingly irritated taxpayer why a policy or procedure has changed, why nobody appears to have told them it changed and why the taxpayer, regardless, must comply immediately with the new arrangement because, after all, government makes the rules. And the taxpayer’s role in this particular exercise is apparently to keep up.

I am not convinced this is what economists had in mind when they described allocative efficiency.

What it often looks like is cost shifting dressed up as cost saving.

If support at home does not arrive, a daughter leaves work early and provides it. If disability support is delayed, a partner fills the gap.

If somebody cannot get timely primary care, the condition may deteriorate until another part of the health system has to deal with it.

If an administrative process becomes complicated enough, the citizen spends hours navigating it, while government spends money employing other people to help them navigate what government itself designed.

None of those costs necessarily appear against the budget line that created the problem, which means one department can appear admirably efficient while another department, a hospital, an unpaid carer, an employer or the person themselves quietly picks up the bill.

That is not necessarily saving money; sometimes it is simply moving the invoice.

There are ways and ways of rationing services and managing queues, because people can be told honestly that demand exceeds supply, given clear information about where they stand and dealt with by somebody who has enough authority to resolve a problem. Or they can be sent through forms, assessments, reassessments, changing rules and another queue until they either reach the service or run out of energy trying to reach it.

At the very end of that process is the point nobody likes to discuss, because eventually the phone can go dead at their end.

The person is no longer asking when somebody is coming to help them shower, no longer trying to establish where their support has gone and no longer requiring another explanation about why the thing they were assessed as needing has still not arrived.

The queue has become shorter, although I am not sure that is an efficiency dividend worth celebrating.

There is also a human cost which is much harder to locate in an annual report, because being made to repeatedly prove that you are old enough, sick enough, disabled enough or sufficiently incapable of managing without help has a way of changing how people understand their relationship with government.

The message may never be intended, but after enough waiting and enough procedural hurdles it can begin to sound remarkably like this: your shower can wait, your assessment can wait, your support can wait and therefore, by extension, you can wait.

That is where the economics of rationing becomes the economics of irrelevance.

Before governments cut another position, tighten another administrative rule or congratulate themselves for containing expenditure by moving somebody six places further down a queue, perhaps they could apply the same marginal-benefit analysis they so readily apply to the service itself and calculate what the rationing actually costs.

Because after we have paid everyone required to assess the shower, approve the shower, delay the shower, review the delayed shower and explain why the shower still has not happened, there remains the distinctly unfashionable possibility that it might have been cheaper simply to provide the shower.