Future of hearing services in Australia
Hearing health and wellbeing a national health priority
Hearing health doesn’t get the priority needed to address the massive social, health and economic costs of hearing impairment to individuals and society in Australia.
With an ageing population, hearing loss is projected to increase to one in every four Australians by 2050.
Hearing loss ranks as a major cause of years of healthy life lost due to disability. A 1999 Australian Institute of Health and Welfare study of the burden of disease, found that adult-onset hearing loss was the fifth highest cause of years of healthy life lost due to disability.
A significant component of acquired hearing loss 37 per cent is due to excessive noise exposure from inappropriate listening behaviours. Spending money on education to prevent hearing loss could be effective in reducing the projected increase.
Hearing loss is associated with increasing age, rising from less than 1% for people aged younger than 15 years to three in every four people aged over 70 years.
Given that a significant component of hearing loss is preventable, there is a clear argument for identifying hearing loss as a national health priority; and for a cross-jurisdictional approach to awareness and preventing and remedying hearing loss.
hearing health needs to be dealt with as a mainstream health issue
hearing loss increases risk of depression, dementia, blood pressure and heart conditions
the Government has nine national health priority areas such as obesity and asthma – hearing should become a priority too
this will raise public profile, education, prevention, supports, and research to direct smart, integrated government policy.
You can read our submission to the Government on why hearing heath and wellbeing must become a national priority.
Hearing services in the National Disability Insurance Scheme
The Australian parliament is looking at hearing services under the National Disability Insurance Scheme (NDIS).
Current issues are explored in our following submissions:
submission to a parliamentary inquiry into hearing services within the NDIS
submission to the Productivity Commission regarding costs of hearing services in the NDIS.
The issue of eligibility
Reports from consumers show there hasn’t been a consistent approach to providing access to the NDIS for people with hearing disability across Australia, so clear guidelines are needed for those who do the assessments for eligibility.
Some consumers and clinicians have been advised that eligibility for the NDIS is dependent on the person’s average hearing threshold level. Eligibility for the NDIS shouldn’t be based on hearing threshold levels alone. This measure doesn’t provide any information on the impact of the hearing loss on a person’s ability to undertake activities, or participate in employment or socially. An average hearing threshold level can be misleading if viewed in isolation, especially if the person has other disability. We support the holistic approach taken by the NDIS to determine eligibility for the Scheme, which is based on the WHO International Classification of Functioning, Disability and Health. We would be concerned if this was replaced by an average hearing threshold level for people with hearing loss.
People have expressed concern about providing ongoing services to people who are not eligible for the NDIS. It isn’t yet clear if there will be any changes to the way the services are delivered. It is also not clear whether all existing groups, including Aboriginal and Torres Strait Islander people, will continue to be able to access services under the Australian Government Hearing Services Program in the longer term such as children who need hearing assessment services.
There will still be people who will miss out on government funded hearing services. People whose hearing loss isn’t considered to have a significant functional impact will not meet the criteria for the NDIS. Unless these people hold a Pensioner Concession Card they will not be eligible for the Australian Government Hearing Services Program either. People on low income – unemployed people, people in part time employment or those with low paying positions – will still have to fund their own hearing services. They generally can’t afford to update their devices, so they may miss employment opportunities due to the lack of financial support for hearing services.
The NDIS and the Australian Government Hearing Services Program are great programs for those who qualify, but there will be people in need who are left behind as they don’t qualify for any funded supports.
Issues about the sale of hearing aids
The Australian Competition and Consumer Commission (ACCC) released a report in March 2017: Issues relating to the sale of hearing aids.
The ACCC report found that commissions, incentives and other mechanisms designed to drive sales can create a conflict with clinical independence, professional integrity and the primary obligation to consumers.
“Some hearing clinics encourage clinicians to sell more expensive hearing aids by setting sales targets, paying commissions to clinicians, having arrangements that favour certain brands or are owned by companies that manufacture hearing aids. Commission-based selling can provide incentives to clinicians to supply hearing aids that are unnecessary or more expensive than a consumer needs. This has the potential to lead to consumer harm where trusted advice is being given to patients, many of whom may be vulnerable or disadvantaged,” ACCC Commissioner Sarah Court said.
commissions, incentives and sales targets are pervasive in the audiology industry
sales practices might be misleading or unconscionable – if proven would raise serious concerns under the Australian Consumer Law
some clinics are in relationships with finance providers
ACCC urges industry to make changes
ACCC has “strong view” that giving more information to customers won’t protect consumers
governments can look at regulatory models that might limit or remove commission based sales
clinics can look at separating the provision of health services from the retail environment.
We note that the ACCC report highlights a lack of transparency that puts the consumer at risk at a time when they are most vulnerable.
The practice of upselling, commissions and bundling the cost of a device with follow-up rehabilitation service is an area of risk for consumers who may have no objective way of knowing whether the device recommended by an audiologist is best suited for their individual needs. The arrangement where a hearing care professional receives a financial payment for promoting a particular product brings in a level of uncertainty to a relationship that needs to be built on trust. Consumers don’t want the advice they receive to be any way influenced, or compromised by the payment of a financial incentive to the clinician.
While acknowledging that not all hearing clinics have this practice, we believe that audiologists would prefer to be rewarded for their expertise and the results they achieve for their clients.
We support the recommendations of the ACCC and would like to work with the hearing industry to help it develop alternative remuneration structures that reward quality and outcomes over sales.
Hearing assistance in aged care
Seven in ten older Australians have hearing loss, but the staff of age care service providers and in hospitals are seldom sufficiently trained to help.
It’s often not realised that even a slight to moderate hearing impairment, if not managed, can inhibit social interaction resulting in significantly reduced quality of life and may also increase depression and dementia.
The long-standing lack of adequate hearing assistance to residents who need it, has resulted in a common misconception that addressing this need is largely a matter for residents and their families. The fact that some care staff do however provide effective hearing assistance in the course of their normal duties demonstrates that this assistance can be provided as part of normal personal care. There is also a common misconception that attending to the needs of hearing impaired residents increases the already heavy workload of care staff. In fact, hearing assistance, if undertaken systematically and competently, adds little additional work and brings enormous benefit for both staff and residents. Home care staff will need the same training as their residential counterparts.
An effective hearing assistance program will benefit staff as well as those they care for and if performed systematically should not be time consuming.
We have a range of free training resources in hearing assistance for nurses and other care staff in aged care services and hospitals. The resources include learning modules, a good practice guide and an instructional video.
The resources are also useful for carers and volunteers who work with hearing impaired people in the community.
You can find these resources on our training resources page
Medical Benefits Scheme (MBS)
Medicare benefits are payable for professional health services. A professional service is a clinically relevant service that is listed on the MBS. A medical service is clinically relevant if it is generally accepted in the medical profession as necessary for the appropriate treatment of the patient.
The audiology items require a review by the Government to bring them into line with current clinical practice. This includes the need for a review of the rules that apply to existing items and the inclusion of additional items to cover new diagnostic procedures.
Some of the rules governing the MBS in relation to referrals to and from audiologists require review in order to make the system more efficient. This change, if implemented, would result in it being more patient focussed.
It would be reassuring for consumers to know that the MBS items were based on evidence based practice guidelines and were regularly updated to reflect current practice recommendations. This would remove the risk of their practitioner providing an MBS approved service that had been replaced due to new evidence or an updated procedure.
Poor-quality automated online captions
We are part of a group of not-for-profit organisations representing people who rely on captions for information, which draws attention to the growing issue of inaccessibility of online audio and visual content.
We are concerned that while there is an increasing amount of web video content being auto-captioned, the vast majority of these captioned videos are not being reviewed for accuracy, readability or comprehension.
In the same way that any text document published online is reviewed and edited for accuracy, captioned content needs to be reviewed and edited before being published online.
A survey of Australian Government-associated websites found that a wide range of problems exists, ranging from video with no captions, video captions with minor misspellings and videos with completely incomprehensible captions. Access to government information and services, political party policies and parliamentary member’s communications is an integral aspect of our democratic society. When inaccurate captions bar access to this information people who rely on captions are at risk of being excluded from full economic, social and political participation.
You can find out more about captioning on our What is captioning? page