The costs of disability
It has been long recognised that people with disabilities in Ireland have additional costs due to disability. Recent studies by Indecon (2021) and the ESRI (Doorley et al., 2025) have estimated the extent of these costs. Additional costs of disability include:
- Additional living expenses
- Mobility, transport, and communications
- Care and assistance services
- Equipment, aids and appliances, and
- Medicines
Although the results (and methodology) vary somewhat, these studies show that the costs are very significant. The recent ESRI study estimated that the cost of disability is 52-59% of the disposable income of households with disabled members. This corresponds to a cost of €488-€555 per week on average for households affected by disability. It also found that if disability costs were included in poverty estimates, the rate of poverty for disabled people would be significantly higher. Research indicates that costs of disability vary due to a number of factors, including age, household type, and the type and severity of disability.
Addressing the costs of disability
A starting point is that in looking at policy we need to distinguish between (i) income support payments (such as disability allowance) which replace income from employment and (ii) payments/services to meet the costs of disability, which also apply to people in work. Secondly, the costs of disability can be met through cash payments (as in the UK Personal Independence Payment), through services; and/or through providing cash for services (such as the HSE personalised budget pilot).[i]
In Ireland – unlike some but not all developed countries – there is no overall scheme to cover the cost-of-disability but there are a number of payments and schemes which, to some extent, cover disability-related expenses. These include the domiciliary care allowance (for children who require additional care), free travel (access to public transport), household benefits, etc. There are also some other supports such as the disabled drivers and passengers’ scheme, operated by the Revenue Commissioners. And there are obviously a range of social services which address some of the costs of disability, though not in a comprehensive manner.
International experience
Internationally, countries adopt a range of different approaches including cash payments and funding for services. An example of a cash payment is the UK Personal Independence Payment (PIP).[ii] The PIP is the latest iteration of payments dating back for several decades which are intended to address additional living costs for disabled people. It is a non-means-tested payment and is payable regardless of whether people are working or in receipt of income support payments. PIP is intended to assist with daily living costs (if a person needs support with everyday tasks) and with mobility. There is a somewhat complex assessment process which awards points related to a person’s capacity.
As readers might be aware, there have been proposals to reform PIP and it is currently subject to an ongoing review (the Timms Review). As of July 2025, there were 3.8 million PIP claimants in England and Wales (out of a total population of 61.8 million (6%)).[iii] Costs of PIP have increased significantly and are predicted to cost 1.8% of GDP by 2028.
Other countries have chosen different approaches. Australia, for example, adopted the National Disability Insurance Scheme (NDIS) in 2013 (for an overview see Dickinson and Yates, 2023).[iv] The NDIS provides access to specialised disability supports funded directly by the scheme and allocated via individual budgets. The NDIS allocates funding to an individual, with the individual, their guardian or a plan manager purchasing goods and services from suppliers. The scheme is entirely publicly funded and is not means-tested. Receipt of support under NDIS does not affect a person’s entitlement to income support payments. People in employment can also receive support from the NDIS.[v] The NDIS funds disability supports but not healthcare-associated costs which are addressed under the Australian system of healthcare. In 2024-2025, the NDIS expenditure in Australia was approximately 1.7% of GDP, with projections to reach 1.95% by mid-2026.
Research indicates that there is a strong return on this investment. In Australia, it is estimated that the NDIS directly creates several hundred thousand jobs (Per Capita, 2021) and, of course, improves the quality of life of people with disabilities (Independent Review of the National Disability Insurance Scheme, 2023). In the UK, research found that receiving disability benefits (PIP) significantly enhances life satisfaction of recipient disabled people (Rodriguez Cabrera, 2025). Qualitative research in the UK found that this type of benefits enabled people to afford to pay for services and items they need; had a preventive role in helping people avoid moves into residential care, and maintaining or avoiding deterioration in health; and had a key role in reducing potential demand for formal services (Corden et al., 2010).
Proposals for reform
In Ireland, proposals in this area go back at least as far as the Commission on the Status of People with Disabilities in 1996. The Commission proposed the introduction of a graduated Costs of Disability Payment to meet the additional everyday costs associated with disability. This payment would be made irrespective of whether the person is at work or not. Since then, successive governments have successfully avoided taking any substantive action on this recommendation.
An interdepartmental committee was subsequently established to consider the issue under the then-social partnership agreement (Towards 2016). This concluded that the introduction of a cost of disability payment was dependent on both the availability of comprehensive data and, in particular, a structured process of the assessment of need.[vi] In Budget 2019, it was announced that funding would be made available to commission research into the cost of disability which led to the 2021 Indecon report. In parallel, a demonstration pilot system of personalised budgets has been established following recommendations from a 2018 Task Force on Personalised Budgets. This is administered by the HSE and is currently being evaluated.
The current 2025 Programme for Government (Securing Ireland’s Future)includes a commitment to ‘[i]ntroduce a permanent Annual Cost of Disability Support Payment with a view to incrementally increasing this payment’. The National Human Rights Strategy for Disabled People 2025-2030 somewhat vaguely states that:
All Government Departments will develop and implement whole-of-Government solutions that will address the cost of disability experienced by disabled people. These solutions will acknowledge the disproportionate financial burden experienced by disabled people and their households in daily living.
These actions will include the Annual Cost of Disability Payment as well as the enhancement of services and ‘other measures’ to reduce the cost of disability.
It is not very clear how this proposed payment is intended to operate but it may be that this would be similar to the ‘cost of living’ increase (sometimes called the disability support grant) paid with disability payments in recent years (an annual top-up of €400-500). If so, this would be a once-off flat rate payment to people in receipt of long-term disability payments. Such an approach would be unlikely to meet any significant proportion of the actual costs of disability and would not vary according to those costs. Secondly, such an approach would not include all those people with disabilities who are not in receipt of disability payments in particular people in work. This would create further disincentives for people with disabilities to take up employment. Given the already low rate of employment for people with disabilities in Ireland and the high ‘disability employment gap’, this would be a step in the wrong direction (see OECD, 2020, 2021).[vii] While, no doubt, any increase in disability payments would be welcomed, it is not clear that such a measure (if this is what is intended) would address the costs of disability identified by studies like the ESRI in any meaningful manner.
The examples of Australia and the UK show that the cost of addressing the costs of disability in a significant way are likely to be quite expensive from an Exchequer perspective. However, the example of these countries show that it is possible and this also indicates that in Ireland these costs are currently being met by people with disabilities rather than being shared across the population. Of course it is not necessary, as a first step, to introduce a scheme which would be a broad as the schemes in Australia and the UK.
In an Irish context, in order to identify the best option(s) we need to look at the views of disabled people, what would fit best into our system of supports and what would be most effective and efficient in meeting the costs of disability. Current government policy might appear to be that each government department should take action in its own area to address disability costs. But unless this is done in a co-ordinated and coherent manner, this approach runs the risk of being an inefficient and ineffective approach.
Conclusion
Despite the challenges outlined above, there have been limited reforms of social protection policy in recent years and little if anything has been done to address the costs of disability in any coherent manner.[viii] As a first step, there is a need to develop a consensus that significant reform is needed in relation to meeting the costs of disability. While the commitment in the programme for government might be seen as recognising this, arguably that commitment rather indicates that policy-makers do not understand what is involved, i.e. the extent of costs involved and the issues (and expenditure) involved in addressing them.
Secondly, there is a need to develop detailed proposals as to what that reform might look like drawing on international experience of what works (and what does not) in meeting the costs of disability. In doing so, it will be essential that the views of people with disabilities and their representative organisations are central to the discussion, i.e. to ensure co-design of the scheme (see e.g. O’Sullivan et al., 2025).[ix]
| Co-design in disability is a collaborative, inclusive process where people with lived experience of disability work with policymakers, and organizations to create better services, products, and policies, ensuring solutions genuinely meet user needs by sharing decision-making power from start to finish. It moves beyond simple consultation, embedding diverse perspectives and strengths to develop more appropriate, accessible, and user-friendly outcomes for everyone. |
Since the publication of this paper, the Department of Social Protection has launched a public consultation on the costs of disability at https://www.gov.ie/en/department-of-social-protection/consultations/public-consultation-on-the-cost-of-disability/
References
Corden, A., Sainsbury, R., Irvine, A., & Clarke, S. (2010). The impact of Disability Living Allowance and Attendance Allowance: Findings from exploratory qualitative research. Department for Work and Pensions.
Dikinson, H and S. Yates (2023). ‘A decade on: The achievements and challenges of the National Disability Insurance Scheme’s implementation’ Australian Journal of Social Issues, 460.
Doorley, K., Kakoulidou, T., and Simon, A. (2025). Adjusting estimates of poverty for the cost of disability, Jointly-published Reports 8, Dublin: ESRI and Irish Human Rights and Equality Commission (IHREC), https://doi.org/10.26504/jr8
Indecon International Research Economists (2021). The Cost of Disability in Ireland, Department of Social Protection at https://www.gov.ie/en/department-of-social-protection/publications/the-cost-of-disability-in-ireland-research-report/
Independent Review of Adult Disability Payment, Final Report, Scottish Government (2025) at https://www.gov.scot/publications/independent-review-adult-disability-payment-final-report/
Independent Review of the National Disability Insurance Scheme (2023). Final Report, Commonwealth of Australia at https://www.ndisreview.gov.au/sites/default/files/resource/download/working-together-ndis-review-final-report.pdf
OECD. (2010). Sickness, Disability and Work: Breaking the Barriers. OECD. Available: https://www.oecd.org/publications/sickness-disability-and-work-breaking-the-barriers-9789264088856-en.htm
OECD (2021). Disability, Work and Inclusion in Ireland: Engaging and Supporting Employers, OECD Publishing, Paris, https://doi.org/10.1787/74b45baa-en
O’Sullivan, D., Murphy, E., Boland, S., Fitzgerald, P., Doyle, J., Becevel, A., & Geisel., U (2025). Inclusion4EU: Co-Designing Digital Futures for Older Persons and Persons with Disabilities. PublicPolicy.ie, 8 July: https://publicpolicy.ie/papers/inclusion4eu-co-designing-digital-futures-for-older-persons-and-persons-with-disabilities/
Per Capita (2021). False Economy: The economic benefits of the NDIS and the consequences of government cost-cutting. Per Capita at https://percapita.org.au/our_work/false-economy-the-economic-benefits-of-the-ndis-and-the-consequences-of-government-cost-cutting/ Rodriguez Cabrera, K. (2025). More than money: The lifelong wellbeing impact of disability benefits, Pro Bono Economics,
[i] A personalised budget is an amount of funding allocated by the HSE to a disabled person, enabling them to make arrangements to access specialist disability services which best meet their individual needs. This pilot is currently being evaluated.
[ii] PIP helps towards some of the extra living costs arising from having a long-term physical or mental health condition or disability that is expected to last for 12 months or longer. Of course, there are also a range of social care services and cash for care payments in the UK.
[iii] Scotland has a somewhat different approach. This has recently been reviewed, see Independent Review of Adult Disability Payment (2025).
[iv] Despite the name, it is not an insurance scheme in the traditional social insurance sense, i.e. you do not qualify based on social insurance contributions.
[v] In fact, the NDIS also funds supports in employment to help participants find, get, and keep jobs by providing funding for workplace help, training, and other services.
[vi] Dáil Debates, Tuesday, 20 Apr 2010.
[vii] The disability employment gap is the gap between the employment rate for the general population and that for disabled people. International studies show that this is higher in Ireland than in most developed countries. The National Disability Authority cites an employment gap for Ireland of 37%, the highest in the EU and much higher than the EU average of 21.4%.
[viii] Indeed, ‘progress’ in this area has arguably been negative in that the mobility allowance was abolished (for new applicants) in 2013 and a promised replacement scheme has never materialised.
[ix] Interestingly, the NDIS legislation has been amended to embed the principle of ‘co-design’ with scheme participants into the legislation.