In this financial year, the federal government predicts it will spend $21.6 billion on aged care, $17.9 billion on the National Disability Insurance Scheme and $8.3 billion on child care subsidies.

These relatively new programs are very expensive. No one is opposed to better services in these crucial areas.

But are we getting good value for our money, especially in regional areas?

There is evidence, I think, a better approach is needed to the way these services are delivered. In short, this involves genuine effort to train up the workers involved, and regulate what has become a sector where profiteers abound.

The growth of the health care and social assistance sector comes on the back of this enormous new spending on aged care, disability support, and child care. The most recent labour force statistics are telling.

For NSW as a whole, the health care and social assistance sector has grown by 114,000 jobs since 2014, an increase of 26.2 per cent, the most substantial jobs uplift for any of the state's employment sectors. In the Newcastle-Lake Macquarie urban area, the health care and social assistance sector is now the largest employment sector with 41,400 workers. The sector is responsible for more than half of the wider city's jobs growth over the past five years.

This pattern is repeated in the remaining portion of the Hunter. There, with its 19,300 workers, the health care and social assistance sector tops all other sectors, with the sector accounting for 40 per cent of all jobs growth over the past five years.

What's not to like about government spending on much needed services delivered direct to where people live, with local jobs as a bonus?

I have three concerns. The first is the absence of quality control measures. The care sector doesn't have the history of success that we find in Australia's education and health institutions. In our schools, universities, colleges, hospitals, medical centres, right down to GP surgeries, there are layers of regulations and practices sitting alongside strict supervision of qualifications and employment conditions. These ensure high quality education and health services irrespective of where you live.

Sure, standards are sometimes not up to scratch, but these deficits are able to be complained about and remedied, simply because of their variation from what is delivered elsewhere.

However, in the newer care programs - aged care, NDIS, child care - the emphasis is on delivering funding direct to the user in the belief that a market for services will emerge and that consumer choice will drive best results. So My Aged Care recipients are assessed for a level of care, and then given financial help to engage a provider of choice. The NDIS operates similarly; while in child care, subsidies follow the choice of the parent in their selection of options from a range of, at times, baffling offerings.

A second concern flows from the first. It has become commonplace for the for-profit providers - not surprisingly chasing the big bikkies in the aged, disability and early childhood services market - to maximise earnings by employing lesser qualified staff on poorer wages and salaries than what professionally qualified staff would accept.

Moreover, staff rosters with fewer professionals are easier to fill in smaller centres where qualified professionals are thin on the ground.

A third concern is that away from the larger urban centres, with other economic sectors in decline, communities can become dominated by concentrations of care-dependent households. As rural industries struggle in the Upper Hunter, for example, skilled workers with young families leave town seeking work down the coast, leaving a disproportionate number of immobile retirees and ageing farmers in districts increasingly dominated by lowly paid care workers.

It's a picture of rural life with little appeal.

Academics call this approach to care, the personalisation of services, where government programs hand money direct to those in need of care so they can choose services from an imaginary, pool of quality suppliers.

Unfortunately, in the real world profit seekers see such a market as a place where standards are readily sacrificed and well-meaning care workers easily exploited.