• 11.1 Individual Costs
• 11.2 Annual Numbers Seeking Treatment
• 11.3 Ministry of Health Costs for DHB Ophthalmology Services
• 11.4 Pharmaceutical Management Agency Subsidies for Eye Related Drugs
• 11.5 Disability Support Services
• Footnotes

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The following section examines the individual and societal costs of blindness associated with medical and other health services.

11.1 Individual Costs

11.1.1 Medical and Health Consultations

Frequency of Consultations and Treatments

Respondents were asked whether, because of their blindness or vision impairment, they had consulted or received treatment from health professionals in the last twelve months. Health professionals commonly consulted include ophthalmologists (52% of all respondents), General Practitioners (33%), optometrists (29%), pharmacists (25%), podiatrists and chiropodists (25%) and counsellors, social workers or psychologists (6%).

Most (82%) respondents consulting an ophthalmologist report one to two consultations in the last twelve months. Ten percent report three to five consultations while 7% report six to ten consultations.

Eighty percent of respondents consulting optometrists also report one to two consultations in the last twelve months. Eleven percent report three to five consultations.

General Practitioners (GPs) are generally visited most frequently. Half (52%) of respondents visiting a GP have done so between three to five times in the last year and 10% have visited six or more times a year.

Pharmacist consultations are also frequent. Approximately a third (32%) of respondents using pharmacists have done so six to ten times in the last year and 21% have consulted pharmacists ten or more times. A further 38% report between three to five pharmacist consultations in the last year.

Personal Costs for Medical Consultations and Treatments

There is some variance in the proportion of respondents incurring at least some personal costs as a result of consultations or treatments received for their blindness or vision impairment. Personal costs are commonly incurred for GP consultations (80% of those consulting a GP), podiatrists and chiropodists consultations (78%) and optometrist consultations (64%). Personal costs are less commonly incurred for pharmacist (42%)

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and ophthalmologist (39%) consultations and least commonly incurred for occupational therapists (12%) and consultations with counsellors, social workers or psychologists (0%).

For those consultations and treatments undertaken most frequently, ophthalmologists represent the greatest personal cost to recipients, on average a total of $317.13 in the last twelve months. Optometrist consultations provide the next greatest total cost, on average $198.95 annually. Consultations with podiatrists and chiropodists ($132.18), pharmacists ($125.24) and GPs ($116.05) also cost on average over $100 each year.

Time Spent Travelling to and from Medical Consultations and Treatments

The time spent travelling to and from consultations and treatment is also examined. Reflecting the more local provision of GPs, pharmacists, optometrists, podiatrists and chiropodists, most travel to these consultations takes an hour or less. Relatively less access to optometrists is, however, suggested in provincial and rural areas. Twenty percent of provincial respondents consulting optometrists spend between two to three hours travelling to each consultation. Thirteen percent of rural respondents consulting optometrists spend between one and two hours travelling per consultation while nine percent travel for more than three hours.

Greater travel requirements are also generally shown for consulting ophthalmologists. While 77% of respondents consulting ophthalmologists travel an hour or less for each consultation, 16% travel between one to three hours and 7% travel for more than three hours. Travel is again shown to be particularly onerous for rural respondents, with 16% of those consulting ophthalmologists travelling more than three hours to do so.

Support and Assistance Required

When excluding help from drivers of taxis or public transport (24), many respondents do not require other assistance in order to attend medical consultations and treatments. For consultations or treatments most frequently undertaken, assistance is most likely to be required for ophthalmologists (24%), podiatrists and chiropodists (16%), GPs (15%) and consultations with counsellors, social workers or psychologists (13%).

Relatively few respondents require additional assistance attending pharmacists (9%) and optometrists (5%).

Probably reflecting the travel distances required, the need for additional assistance to consult GPs, ophthalmologists, optometrists, podiatrists and chiropodists is greatest for

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those living in rural locations when compared to those living in provincial or urban locations. Over a third (39%) of rural respondents consulting ophthalmologists require assistance, as do a third of those consulting podiatrists and chiropodists.

Across most consultation and treatment types requiring assistance, family members are identified as providing all or most of the assistance provided. The only exception to this is consultations with occupational therapists, where 69% of those providing assistance are identified as society helpers.

Of those consultations most likely to require assistance, ophthalmologist consultations require the greatest amount of family assistance (216 minutes per consultation), followed by GP consultations (59 minutes) and podiatrists and chiropodists (38 minutes).

All family members providing assistance are unpaid, while most society members are paid in full by society sources.

Total Medical & Health Consultation Financial Costs

Total annual financial costs associated with medical and health consultations are estimated at $1.9m for the Foundation membership. This includes costs of any consultation fees or payments to helpers by the individual or their family.

Table 43: Annual Medical and Health Consultation financial costs to the individual and society

Elderly (65+ years) vision impaired account for 58% ($1.1m) of total financial costs associated with medical and health consultations, followed by elderly blind (16%, $301,000) and working aged (18-65 years) vision impaired (14%, $269,000). Blind youth (under 18 years) account for the least financial costs associated with medical and health consultations ($15,000).

Total Medical & Health Consultation Time Costs

Total annual time costs associated with medical and health consultations are estimated at $26,000 for the Foundation membership. This includes costs for time spent by the family andor society in providing help or support to attend medical consultations. .

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Individuals bear 69% of time costs associated with medical and health consultation. Costs are equal for blind and vision impaired persons.

Table 44: Annual Medical and Health Consultation time costs to the individual and society

Elderly (65+ years) blind account for 35% ($9,000) of total time costs associated with medical and health consultations, followed by elderly vision impaired (23%, $6,000) and working aged (18-65+ years) vision impaired (19%, $5,000).

11.1.2 Medication and Drugs

Almost a third (31%) of all respondents report taking prescription drugs in the last twelve months directly for their blindness or vision impairment. Of these respondents, 74% report having incurred at least some personal cost in purchasing the drugs taken, with these respondents paying an average of $204.47 a year.

Only 7% of all respondents report taking non-prescription drugs in the last twelve months directly for their blindness or vision impairment. Of these, 77% report having incurred at least some personal cost in purchasing the drugs taken, spending an average of $81.08 a year.

Sixteen percent of all respondents report taking herbal remedies or vitamins in the last twelve months directly for their blindness or vision impairment. Of these, 89% report having incurred at least some personal cost in purchasing the remedies or vitamins taken, on average, $138.25 a year.

Total Medication and Drugs Financial Costs

Total annual financial costs associated with medication and drugs are estimated at $817,000 for the Foundation membership. This includes costs incurred by individuals and families in purchasing prescription, non prescription and herbal medication taken for their vision impairment.

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Table 45: Annual Medication and Drugs financial costs to the individual and society

Elderly (65+ years) vision impaired account for 72% ($585,000) of total financial costs associated with medication and drugs, followed by working aged (18-65 years) vision impaired and elderly blind (9%, $75,000).

11.1.3 Secondary Health Conditions

Just over a third (35%) of all respondents report secondary health conditions or injuries related to their blindness or vision impairment.

Grazes, cuts and bruises are most commonly experienced (58% of respondents experiencing other conditions or injury). Also common are sprains or strains (20%). Less common are psychological problems (9%), broken bones (7%), headaches (6%) and dislocations (5%).

While not financially quantified, a range of further costs are reported as a result of each secondary condition or injury sustained. For example, for those suffering grazes, cuts and bruises, costs reported include loss of quality of life (61%), time spent travelling to and from medical appointments (42%), consultations with medical professionals (34%), rehabilitation from health professionals such as physiotherapists and occupational therapists (14%), and prescription (14%) and non-prescription drugs (9%).

For those suffering sprains and strains, reported costs include loss of quality of life (68%), time spent travelling to and from medical appointments (54%), consultations with medical professionals (52%), rehabilitation from health professionals such as physiotherapists and occupational therapists (24%) prescription (23%) and non-prescription drugs (11%), time off work (9%), and loss of income (6%).

While not quantified, examination of who met the resultant costs shows much of the cost burden falling on to the individual. For example, individuals suffering grazes, cuts and bruises are shown to have incurred all associated travelling costs as well as all the costs of

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prescribed and non-prescribed drugs. Where consultation was required from a medical professional, the individual is reported to have incurred at least some personal cost for 76% of treatments identified. Society is more clearly shown to incur the cost for rehabilitation services such as physiotherapy, with 64% of treatments reported to have been paid for by government agencies such as ACC.

The individual cost burden is further described for those individuals suffering sprains and strains. Once again the individual incurs all the cost of prescribed and non-prescribed drugs. Most (97%) consultations for medical treatments result in at least some personal costs to the individual, as does the time spent travelling to such consultations (88%).

One participant describes the consequences of an injury suffered because of her blindness:

"The last one, which was a bad one, wrecked both my knees. I was injured in five places and it took me a year of physio at the hospital to get over that and sort my legs out. There have been ongoing consequences of that. That was because I never saw the obstacle that was in my way on a pavement, left there by kids." (Female Older Adult)

11.2 Annual Numbers Seeking Treatment

Every person seeking medical treatment in New Zealand has a National Health Index number allocated for medical treatment and prescription records. The National Health Information Service collates treatment data but was unable to provide information about the number of people seeking treatment for blindness and vision impairment related conditions for this study. A major concern was patient record confidentiality. Another issue was that medical treatment information is categorised using a framework that is not sufficiently detailed to allow records to be identified according to the blindness and vision impairment definitions this study uses.

Currently there are approximately 100 ophthalmologists operating in New Zealand in the public and private sectors, as well as independent optometrists. Collecting records from individual operators would be an exhaustive process and neither the New Zealand Association of Optometrists nor the Royal Australian and New Zealand College of Ophthalmologists collects data from their members about clients.

The Ministry of Health collects information for budgeting requirements on volumes of patient services contracted from the District Health Boards on an annual basis. This is the best estimate of the number of people seeking treatment from ophthalmologists, as other organisations could not release patient records. However, clients receiving services or treatment from DHB ophthalmology departments may not meet the WHO definition of blindness or vision impairment, as anyone with an eye related issue (for example an eye

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related accident that does not cause vision impairment) could visit an ophthalmology department for treatment. Therefore, these figures overestimate the number of people seeking treatment for blindness and vision impairment. Information could not be provided for a few DHBs, and client information from Counties Manukau and Canterbury has been highlighted as potentially unreliable.

Table 46 shows Ministry of Health contracted volumes for ophthalmology services by DHB for the 2003/2004 financial year. Approximately 46,000 events are budgeted for first time visits to ophthalmology clinics throughout the year. Nearly one third of appointments will be conducted by Auckland DHB (14,200 visits). Canterbury, Capital and Coast and Waikato DHBs will have approximately 10% of total New Zealand visits each (14-20,000 visits). There will be approximately 108,000 visits to ophthalmology clinics by clients who have previously attended ophthalmology clinics. Approximately one quarter of visits will occur at Auckland DHB ophthalmology clinics (25,800 visits).

Ophthalmology departments will have approximately 8,850 inpatient events in 2003/2004. Auckland DHB provides two and a half times more inpatient services than expected based on its share of total New Zealand population.

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Table 46: Ministry of Health Contracted Ophthalmology Services by DHB (2003/2004 financial year)

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11.3 Ministry of Health Costs for DHB Ophthalmology Services

Alongside the contracted volume of clients by DHB, the Ministry of Health provided the budgeted value of ophthalmology service and treatment provision for the 2003/04 financial year (Table 47). In total the Ministry of Health will be funding approximately $44m of ophthalmology department services and treatment. More than half of the expenditure will relate to inpatient services ($24m). Subsequent visits will make up 27% of expenditure ($12m). Auckland DHB will receive 27% of total expenditure in line with the over representative number of clients. Auckland DHB receives 58% of funding for minor eye procedures.

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Table 47: Ministry of Health Budgeted Value of Ophthalmology Services and Treatment (2003/04 financial year)

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11.4 Pharmaceutical Management Agency Subsidies for Eye Related Drugs

As with the Ministry of Health and Accident Compensation Corporation, Pharmaceutical Management Agency (Pharmac) statistics cover all eye related medications and treatments, not just those relating to the treatment of blind and vision impaired individuals. Figure D shows Pharmac expenditure on eye and some ear related drugs and prescriptions for the 1999-2003 financial years. In 2003 Pharmac spent $8.7m on drugs and $570,000 on prescriptions for eye and ear related treatments. Since 1999 expenditure on eye and ear related treatments has increased by 31% ($2.2m).

Figure D: Pharmac Expenditure on Eye and Selected Ear Related Drugs and Prescriptions (1999-2003)

11.5 Disability Support Services

Disability Support Services are an individualised range of services from home based support to residential support services. The Ministry of Health is the major government funder of Disability Support Services, however other agencies such as the Ministry of Education, ACC and WINZ provide support services also. Under the New Zealand Public Health and Disability Act 2000, the Ministry of Health purchases Disability Support Services at the national level, with most contracts being administered by four regional offices.

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To qualify for assistance, a disabled person must meet the Ministry of Health's definition of disability; that is to "be assessed as having either a physical, intellectual, sensory, psychiatric or age related disability, or a combination of these, where the disability is likely to continue for a minimum of six months and result in reduction of independent function to the extent that ongoing support is required."

Once eligibility for Disability Support Services assistance is established, the following three processes form the basis for access to Disability Support Services funding.

• Needs Assessment: identifies and prioritises a persons care and support needs, irrespective of funding constraints and availability of services.
• Service Co-ordination and Planning: identifies the most appropriate services and support options to meet assessed needs and outcome goals, within available funding.
• Provision of Services: individual support package of service for the disabled person and their family where appropriate.

The Ministry of Health has provided detailed client records of funding by service type for the 2002 and 2003 financial year for clients with a Sensory Disability. This is the finest level of detail collected by the Ministry of Health, therefore the funding levels provided include information on individuals with hearing impairments as well as vision impairments.

Table 48 shows the number of clients receiving Disability Support Services and the volume of funding for each service type excluding GST for the 2002 and 2003 financial year. There were 7,300 clients in 2001/2002 and 8,700 clients receiving support for sensory disabilities in 2002/2003. Each client can receive support for more than one service so the number of clients for each service does not add to the total number of clients receiving services. The value of Disability Support Services increased from $91m in 2001/2002 to $103m in 2002/2003 (13% increase). Community Residential Care for Clients with Intellectual Disability accounted for approximately 26% of total funding in 2002/2003 ($27m). Home Support (mainly household management and personal care) accounted for 24% of total funding in 2002/2003 ($24.8m).

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Table 48: Number of clients receiving Disability Support Services and Funding by Service Type (2001/2002 and 2002/2003 financial years)

11.5.1 Summary of Costs Associated with Medical, Assessment and Service Provision

Costs of Blindness experienced in relation to medical costs as covered in the RNZFB Costs of Blindness Survey are summarised in Table 49 below.

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Summary Table 49: Annual costs of Transport and Mobility to the individual and society

Footnotes

24. Accounted for elsewhere in the survey see Transport and Mobility.

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