Background
1.1
Approximately 3.6 million Australians experience hearing loss and, with Australia’s growing ageing population, the prevalence of hearing loss is expected to more than double by 2060. Currently, approximately three in every four Australians over the age of 70 experience hearing loss.
1.2
In 2017, hearing loss is expected to cost the Australian economy approximately $33.3 billion, of which the loss of wellbeing to individuals is valued at $17.4 billion.
1.3
For some individuals, the impact of hearing impairment may include: reduced self-esteem, difficulties finding and maintaining employment, reduced social interaction, and a higher likelihood of a range of associated mental and physical conditions.
1.4
In addition, hearing impairment is having a profoundly negative impact within Aboriginal and Torres Strait Islander communities. As many as
90 per cent of Aboriginal and Torres Strait Islander children in some remote communities have otitis media (middle ear) infections at any time. Reoccurring or persistent ear infections can result in permanent hearing damage and are linked to the delayed development of communication skills and reduced educational attainment.
1.5
Despite these issues in rural and regional Aboriginal and Torres Strait Islander communities, Australia is considered to be a world leader in the provision of hearing services to children. This system includes universal hearing screening for babies, the fitting of free hearing devices through Australian Hearing, and the provision of communication support and therapy through multidisciplinary early intervention services.
1.6
With the expected future rise in the number of people who will require assistive hearing devices, developments in assistive technologies, their availability, and cost is a major consideration now and into the future. A recent Australian Competition and Consumer Commission report has drawn attention to sales practices within the hearing aid clinic industry and concerns have been raised that often vulnerable older Australians are being coerced into purchasing more expensive hearing aids than required.
1.7
Framing the current status of hearing health in Australia is the Australian Government’s National Disability Insurance Scheme (NDIS). The NDIS is aimed at providing an improved source of support and assistance for eligible deaf and hearing impaired Australians. The NDIS is expected to result in changes to the way some services are funded and delivered. How the NDIS will affect and support those already receiving and yet to receive hearing health services was a major issue of concern raised during the Hearing Health and Wellbeing Inquiry.
About the Inquiry
Objectives and Scope
1.8
On 2 November 2016, the then Minister for Health, Aged Care and Sport, the Hon Sussan Ley MP, referred the Inquiry into the Hearing Health and Wellbeing of Australia (the Inquiry) to the Standing Committee on Health, Aged Care and Sport (the Committee).
1.9
As part of the Inquiry the Committee reviewed the current state of hearing health in Australia. More specifically the Committee examined:
The prevalence of hearing impairment in Australia and the costs that hearing impairment imposes both on individuals and on the broader Australian community.
The state of hearing health within at-risk population groups. In particular, the impacts of otitis media infections among Aboriginal and Torres Strait Islander children and specific issues relating to access to services and treatment for people from culturally and linguistically diverse backgrounds, people living in rural and regional areas, and older Australians.
Programs to encourage Australians, particularly young Australians, to take action to protect their hearing health and programs to increase awareness of the benefits of seeking treatment for hearing loss.
Sales practices within the hearing aid clinic industry, including the payment of commissions and incentives to clinicians to encourage the sale of hearing aids.
The introduction of the NDIS and its impact on the delivery of hearing services.
Inquiry Conduct
1.10
On 9 November 2016, the Committee issued a media release announcing the Inquiry and calling for submissions to be received by 23 December 2016. The Committee also invited submissions from: government agencies, peak industry and professional organisations, community advocacy and support groups, hearing health providers, universities and research organisations.
1.11
The Inquiry received 150 submissions and 20 exhibits, which are listed at Appendix A and B respectively.
1.12
The Committee subsequently held 11 public hearings as outlined in the table below. The Committee also conducted two inspections in Sydney and Darwin.
Table 1.1: Public Hearings Held
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15 November 2016
6 April 2017
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Sydney, NSW
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14 February 2017
3 March 2017
23 March 2017
16 June 2017
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Canberra, ACT
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21 April 2017
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Brisbane, Qld
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1 May 2017
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Melbourne, Vic
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2 May 2017
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Shepparton, Vic
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3 May 2017
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Adelaide, SA
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7 June 2017
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Darwin, NT
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Previous Inquiries and Reports into Hearing Health
Access Economics Reports on the Economic Impact of Hearing Loss
1.13
In February 2006 Access Economics released the report entitled Listen Hear! The Economic Impact and Cost of Hearing Loss in Australia. The report, commissioned by the Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation and the Victorian Deaf Society, provided a quantitative analysis of the ‘financial cost and the loss of wellbeing from hearing loss in Australia’.
1.14
Access Economics found that one in six Australians (a total of 3.55 million people), was affected by hearing loss in 2005. Taking into consideration Australia’s growing ageing population, by 2050, the prevalence of hearing loss is projected to rise to one in four Australians. In addition, Access Economics estimated that, in 2005, the real financial cost of hearing impairment was $11.75 billion, equal to 1.4 per cent of Australia’s Gross Domestic Product.
1.15
The Access Economics report and its findings were quoted widely in submissions, including submissions from: the Department of Health, Australian Hearing, Better Hearing Australia, the Deafness Forum of Australia, the Northern Territory Government, Audiology Australia, the Shepherd Centre, Independent Audiologists Australia, and the Australian Society of Otolaryngology Head and Neck Surgery.
1.16
In 2017 the Hearing Care Industry Association commissioned Deloitte Access Economics to update the 2006 Listen Hear! report. The updated report estimated the financial cost of hearing loss at $15.9 billion, with the associated value of the loss of wellbeing being $17.4 billion.
Senate Inquiry into Hearing Health in Australia (2010)
1.17
On 10 September 2009, the Senate referred an Inquiry into Hearing Health in Australia to the Senate Community Affairs References Committee (the Community Affairs Committee).
1.18
On 13 May 2010, the Community Affairs Committee presented to the Parliament its report Hear Us: Inquiry into Hearing Health in Australia.
Key Issues
1.19
The 2010 Senate report found that the:
… single issue most raised by submitters to the inquiry was that of eligibility to Australian Hearing services, and especially the cut off age of 21 years. At a time in their lives when they are studying, or not yet established in their careers , young Australians find themselves without the excellent care they have received to date, and often without the means to replace that care, or their hearing devices, in the private sector.
1.20
In particular, the report highlighted the barriers to accessing appropriate treatment for hearing impairment. These barriers included the very high cost of hearing devices for individuals who are not eligible for support from the Hearing Services Program, and the lack of hearing assessment and support services in regional and remote parts of Australia.
1.21
In addition, another issue highlighted was the high rate of ear disease among Aboriginal and Torres Strait Islander people, which was described as a crisis. The report found that the onset of childhood hearing loss ‘can be devastating for Indigenous Australians. [Due to hearing loss] their capacity to access education—arguably the best way out of the poverty cycle—is limited.’
2010 Report Recommendations
1.22
The 2010 Senate report made 34 recommendations in relation to hearing health in Australia, in the areas of:
awareness raising and research;
recreational hearing loss among young people.
Government Response
1.23
On 30 May 2011 the Australian Government in its response to the Committee’s report, accepted a number of recommendations in principle, while noting others were the responsibility of state and territory governments. The majority of the recommendations are yet to be adopted.
1.24
Subsequently, in 2011-12, the maximum age of eligibility for young adults to receive services under the Hearing Services Program was raised from
21 years of age to 26 years of age.
Audit Report of Community Service Obligations Program (2014)
1.25
Following the Senate Inquiry, in 2014, the Australian National Audit Office (ANAO) conducted a performance audit to ‘assess the effectiveness of the Department of Health’s and Australian Hearing’s administration of the Community Service Obligations (CSO) program for hearing services’.
1.26
The ANAO found that ‘overall, the CSO program [was] being effectively administered’, but recommended that:
… the Department of Health establish a methodology, in consultation with Australian Hearing, for measuring performance against the projected service targets and other outcomes for eligible client groups from 2011–12 to 2014‑15.
Senate Inquiry into Australian Hearing (2015)
1.27
On 17 September 2015, the Senate Select Committee on Health, as part of its remit, presented its third interim report entitled Australian Hearing: Too Important to Privatise.
1.28
The Senate Select Committee examined whether the Government should act on the recommendation of the National Commission of Audit 2014 to privatise Australian Hearing.
1.29
As the title of the Senate Select Committee report suggests, broadly it recommended that Australian Hearing should not be privatised.
1.30
The Senate Select Committee report included the concerns raised by stakeholders regarding the proposed privatisation of Australian Hearing. These related to:
maintaining access to hearing services, particularly for parents of deaf children, very young children, and babies;
maintaining standards of service in the CSO program if Australian Hearing were privatised, particularly in rural and remote areas and Aboriginal and Torres Strait Islander communities; and
whether a competitive market would have any incentive to provide the types of services and ongoing research currently provided by Australian Hearing and the [National Acoustic Laboratories].
1.31
The Senate Select Committee also recommended that:
… the government provide clarity around the work already done on the transition of the Hearing Services Program to the National Disability Insurance Scheme. Any 'blueprint' or implementation plan should be made public as soon as it is finalised, so as to reassure stakeholders that the quality services provided by Australian Hearing continue to be available in order to ensure that hearing impaired Australians can live the life they deserve.
Government Senators’ Dissenting Report
1.32
Coalition Senators on the Select Committee released a dissenting report to the Committee’s recommendations. In relation to the Committee’s recommendation against privatising Australian Hearing, the dissenting report advocated that:
Given the Government has not made a decision on the ownership of Australian Hearing and the consultation is ongoing, the Committee should not pre-empt the outcome. Therefore, Coalition Senators reject Recommendation 1.
1.33
In relation to Recommendation 2, which urged the Australian Government to provide more clarity around the work done on the transition of the Hearing Services Program to the NDIS, the dissenting report stated that the Government had provided ‘ample information and clarity’ about the transition.
Australian Competition and Consumer Commission Report (2017)
1.34
In 2015 the Australian Competition and Consumer Commission (ACCC) conducted a survey focussing on ‘consumer protection issues in the hearing clinic industry. In 2017, the ACCC released its findings in its report entitled Issues around the Sale of Hearing Aids: Consumer and Clinician Perspective.
1.35
The ACCC found that within the hearing aid clinic industry ‘sales commissions and incentives are commonly used to motivate clinicians to sell hearing aids, particularly in clinics run by major operators.’
1.36
The ACCC found that sales in hearing aid clinics ‘may be driven by commission and other incentives rather than consumer need.’ The ACCC also outlined issues relating to the ‘cost and performance of hearing aids’ and the ‘treatment of vulnerable consumers’.
1.37
The ACCC stated that it had contacted industry participants and requested that they ‘review their incentive programs and performance measures to ensure that they do not create a conflict between independent healthcare advice and sales.’
Current Inquiries and Investigations into Hearing Health
Inquiry into Hearing Services under the National Disability Insurance Scheme
1.38
On 30 November 2016, the Joint Standing Committee on the National Disability Insurance Scheme (NDIS Committee) commenced an inquiry into the provision of hearing services under the NDIS. The NDIS Committee was originally due to report to the Parliament by 23 March 2017 but its reporting date was, subsequently, extended.
1.39
The inquiry’s terms of reference are to inquire into and report on:
The eligibility criteria for determining access to, and service needs of, deaf and hearing impaired people under the NDIS;
Delays in receiving services, with particular emphasis on early intervention services;
The adequacy of funding for hearing services under the NDIS;
The accessibility of hearing services, including in rural and remote areas;
The principle of choice of hearing service provider;
The liaison with key stakeholders in the design of NDIS hearing services, particularly in the development of reference packages;
Investment in research and innovation in hearing services; and
Any other related matters.
Report Structure
1.40
Chapter 2 outlines hearing impairment and balance disorders in Australia, including: the types, causes, and prevalence of these conditions; the economic costs; and the impacts of these conditions on individuals.
Chapter 2 also outlines the current approaches used to provide services and support for Australians with hearing impairments and balance disorders.
1.41
Chapter 3 discusses hearing health in at-risk populations, including: Aboriginal and Torres Strait Islanders; people from culturally and linguistically diverse backgrounds; the elderly; people living in rural and remote communities; and others.
1.42
Chapter 4 considers the extent and causes of noise induced hearing loss and programs aimed at reducing preventable hearing loss. Chapter 4 also outlines research and innovation in the treatment of hearing impairment and balance disorders.
1.43
Chapter 5 discusses the provision of hearing assistance devices, including: the structure of the hearing clinic industry; the role of Australian Hearing; the cost of hearing devices and available subsidies; the use of commissions and other sales practices in the hearing services industry and potential models for regulating these practices; post-sales support for recipients of hearing devices; alternatives to hearing devices; training, registration, and skill shortages in audiology and audiometry.
1.44
Chapter 6 considers the future of hearing services in Australia, including: the introduction of the National Disability Insurance Scheme; hearing screenings; the availability of Auslan interpreters; ownership of Australian Hearing; and hearing health and wellbeing as a National Health Priority Area.