Funding of hearing aids in New Zealand

Incidence of hearing loss
The NZ Health Survey carried out in 1991/92 showed that 9.8% of people reported having hearing loss. This survey did not include institutionalised people, many of whom would have hearing loss - so probably a more realistic figure is 10.5%. There is a gender difference, with 12.3% of men, and 7.3% of women reporting hearing loss. The prevalence of hearing loss as a function of age and gender is shown in Figure 1.

Funding Schemes
There are six schemes under which hearing impaired people  may receive financial assistance towards the cost of their hearing aids:

• The Special Aid Fund which purchases hearing aids for hearing impaired and deaf children throughout New Zealand
• The NZISS scheme which pays for hearing aids for a very select group of people - usually those who are least in need of financial assistance (those in employment, or in training). This scheme is due to pass to Vote:Health in July 1995, but little change is seen in terms of eligibility. This scheme is designed for physically disabled people, but its eligibility criteria are not very appropriate for hearing impaired people, the vast bulk of whom are elderly, and therefore not in paid employment.
• The ACC scheme which pays for hearing aids for people whose hearing loss was caused by noise exposure or by accident. Most people eligible for assistance under this scheme are men.
• The War Pensions scheme which purchases hearing aids for people whose hearing loss was caused (at least initially) during war service. Again, most people qualifying for assistance under this scheme are men.
• Some medical insurance schemes. Normally a higher level of premium is required for cover including a contribution towards the cost of hearing aids.
• The hearing aid subsidy for adults, which is a flat payment of $89.10 per hearing aid.

NOTE: the hearing aid subsidy was increased to $198 per hearing aid in 2003

Hearing aid subsidy
The hearing aid subsidy originally covered the total cost of a locally produced hearing aid and earmould, but over time it has not kept up with inflation, and now is only a small contribution towards the cost of hearing aids (see Table 1).

Table 1. The value of the hearing aid subsidy over the years since its inception, and its buying power

Many people with hearing loss, who are ineligible for assistance from any of the total payment schemes, are denied the help that hearing aids provide because of the financial barrier. In Auckland public hospital clinics, about 35% of adults assessed as needing hearing aids do not proceed to hearing aid fitting.

A positive change in the buying power of the subsidy as been the changes to Health funding of equipment for disabled people to bring them into line with the NZISS scheme. This has resulted in Accredited Equipment Assessors (in the hearing area, these are audiologists) being authorized to approve hearing aid subsidies. This has removed the need for assessment by an otologist, with a consequent reduction in waiting time and/or cost.

Hearing impaired people are more likely to be in financial need than those with normal hearing. Even with adjustments for population age differences (which would be expected to increase the differences even more), 42% of people with hearing loss have Community Services Cards, compared with 31% of people with no hearing loss (NZ Health Survey).

In other countries, there is much more generous provision of state assistance towards the purchase of hearing aids for elderly people. For example, in Australia, the age level for state provision of hearing aids has recently been decreased from 65 to 60 years. In New Zealand, the only population given total coverage is children. The elderly receive a very poor level of support from the taxpayer. Table 2 shows the actual expenditure on the hearing aid subsidy in 1991.

Table 2. Subsidy expenditure in four main centres of New Zealand (1991)

A comparison of funding for hearing aids for children and elderly hearing impaired (ignoring the NZISS, ACC and War Pensions schemes) for the northern part of the country shows a major inequity. The results are shown in Table 3.

Table 3. State funding for elderly adults and children in the northern part of New Zealand

Apart from the issues of the level of financial assistance provided by the subsidy limiting access to assistance, there are also some concerns regarding the provision of the hearing aid subsidy. With the repeal of the Hearing Aid Regulations, health funders are bound to purchase hearing aid subsidies. However, because of the complexity of the health system, in some cases the subsidy has been withdrawn (eg in Canterbury), and only after protest has it been reinstated. While it is possible that the Health and Disability Commissioner could act as a watchdog, a high level of consumer awareness is necessary to retain what ought to be a citizen's right (and has been under the Regulations for nearly 40 years.

Another facet of the repealed Hearing Aid Regulations which is not being well controlled by health funders is the need for hearing aids to be tested and approved. Testing is carried out by the National Audiology Centre on a cost-recovery basis, for hearing aid importers. All reputable importers are currently happy to have their devices tested by the Centre, but there is currently nothing to stop an unscrupulous operator from dumping sub-standard equipment on the market. A recent case has seen exactly this done, using direct mail selling of a useless and unsafe product.