Effectiveness and Cost-Effectiveness of Models of Healthcare for People With Intellectual Disability in Australia: A Scoping Review.

Abstract

People with intellectual disability experience significant gaps in healthcare delivery resulting in poor health outcomes. Appropriately designed healthcare is required to meet the needs of this population and achieve better health outcomes. Little is known about the structure of healthcare delivery for people with intellectual disability and whether it is effective or cost-effective. To improve health services, this scoping review sought to describe how models of healthcare are structured and summarise evidence for their effectiveness and cost-effectiveness for people with intellectual disability in Australia. A preliminary search of literature describing models of healthcare for people with intellectual disability in Australia was conducted to generate a description of how healthcare is delivered for people with intellectual disability. Following PRISMA-ScR guidelines, an electronic search of peer-reviewed literature of four databases (MEDLINE, CINAHL, PsycINFO and Cochrane Library) was undertaken in August 2024 and updated in February 2025, and websites of government departments of health across Australia were searched for grey literature. All study designs conducted in any healthcare setting in Australia were included if evaluation data were available. Outcome data related to the person with intellectual disability, carers, clinicians/service providers or health services were extracted. Data were synthesised qualitatively. Fifteen publications were identified including 10 peer-reviewed articles and five reports in the grey literature. The following components of healthcare delivery were described: reasonable adjustments, person-centred care, capacity building, care coordination, cross-sectoral coordination and specialist multidisciplinary teams. Each model of care was associated with some evidence of effectiveness. Cost-effectiveness was found with models that used cross-sectoral care coordination. The models of care were heterogeneous, and evaluations indicated positive outcomes including better health outcomes and reduced costs. The scope of evaluations and therefore generalisability of findings was limited. More high-quality research and suitable measures of outcome are needed to guide the design of best practice healthcare for people with intellectual disability. These findings provide important guidance for the implementation of the National Roadmap for Improving the Health of People with Intellectual Disability, a current policy initiative in Australia. The effectiveness and cost-effectiveness of cross-sectoral care coordination suggest that coordinated care at the intersection of the health and disability sectors could improve health outcomes. We suggest that strategies for effective delivery of healthcare are structured and standardised to enable more widespread implementation and evaluation by policy makers and practitioners.