OUTCOME 6 HEARING SERVICES

OUTCOME SUMMARY—THE YEAR IN REVIEW

The Australian Government recognises the importance of providing habilitation and rehabilitation services to those affected by hearing loss through funding access to specialist hearing services under the Commonwealth Hearing Services Program.

The Office of Hearing Services (the Office) administers the Hearing Services Program and delivers:

vouchers for eligible adults to access hearing assessments and devices from the hearing services provider of their choice; and

hearing services for those with special needs by funding the public provider, Australian Hearing, under Community Service Obligations (CSOs).

Services Available through the Commonwealth Hearing Services Program Voucher System

assessment of hearing;

audiological rehabilitation and management, as well as advice and counselling in relation to hearing needs;

appropriate prescription, selection and fitting of quality hearing devices, including advice and counselling about hearing device use; and

maintenance of hearing devices including battery supply and repairs for a nominal annual maintenance fee.

Eligibility under the voucher system is prescribed by the Hearing Services Administration Act 1997. To be eligible, a person must be an Australian citizen or permanent resident 21 years of age or older and the holder of a Pensioner Concession Card,

Department of Veterans’ Affairs (DVA) Gold Repatriation Health Card or DVA White Repatriation Health Card covering hearing loss, or be in receipt of Sickness Allowance from Centrelink. Dependants of a person in any of the categories mentioned above are also eligible.

Other eligible clients include members of the Australian Defence Forces, and clients of CRS Australia undergoing a vocational rehabilitation program who are referred by their case manager.

After receiving vouchers eligible adult clients may choose their service provider from a number of accredited service providers who have a contract with the Office to provide hearing services to eligible clients. Service providers are expected to comply with the Clinical Standards and Rules of Conduct issued by the Office as part of the accreditation and contracting arrangements. As at 30 June 2003, there were 1,174 practitioners, audiologists and audiometrists, working for 142 accredited and contracted service providers. This compares with 139 service providers as at 30 June 2002. The client files of 180 practitioners were reviewed as part of the Office’s quality assurance and procedures (representing over 21 per cent of all practitioners reviewed against the target of 20 per cent of all practitioners) and 29 site audits completed to ensure compliance and accuracy of records. Compliance action, as a result of breaches of either their contractual arrangements or conditions of accreditation, was taken against eight service providers in 2002-03.⁹⁴

New applicants for hearing services vouchers are referred by a medical practitioner, while returning clients are referred by a qualified hearing services practitioner or a medical practitioner. Adult Australians apply for a voucher and upon confirmation of eligibility, are sent by post a voucher, a directory of accredited service providers and other printed information about accessing the program. Centrelink is engaged by the Office to verify client eligibility based on benefit status.

In 2002-03 the contracted service provider network provided voucher services to 385,000 continuing adult clients. This figure represents an increase of 35,000 in the total number of clients from the previous year.

During 2002-03 eligible clients received vouchers, on average, approximately four weeks after receipt of a correctly completed application. This compares with a target for receipt of vouchers approximately two weeks after lodging an application. 161,000 vouchers were issued to new and return clients in 2002-03. The increase to the average time spent in processing vouchers during 2002-03 reflects growth in demand, up 12 per cent or 17,000 on the number of vouchers issued in the previous year. The Office is working with Centrelink to address the timeliness of processing applications. The growth of the program can be attributed, in part, to an ageing population (larger client base) and increasing awareness of the Hearing Services Program.⁹⁵

In 2002-03 the Office completely revised and re- designed the voucher to improve its presentation, in response to feedback from clients and hearing services providers that the voucher contained insufficient information. The Office has received very positive feedback from all stakeholders about the revised voucher.

Another key outcome for the program is the continued usage of hearing devices by clients. In 2002-03 the Office Client Survey indicated that the usage of hearing devices is improving. Fifty- four per cent of return clients (that is, clients who have been fitted with their second hearing device) who responded to the survey advised that they are using their hearing devices for more than eight hours per day. A further 22 per cent advised that they were using their hearing devices for five to eight hours per day, 19 per cent one to four hours per day and only three per cent advised that they were using their hearing devices for less than one hour per day (two per cent provided no response).⁹⁶

These compare favourably with the 2001-02 figures which showed of return clients, 45 per cent were using their hearing devices in excess of eight hours per day, 27 per cent using their hearing devices five to eight hours per day and 21 per cent who were using their hearing devices one to four hours per day. As depicted in figure 6.2 eligible clients of the Commonwealth Hearing Services Program are using their hearing aids for longer periods of time each day. This gradual and noticeable improvement in hearing device usage is consistent with achieving one of the main objectives of the program, that is, to reduce the consequences of hearing loss.

Figure 6.1—Number of vouchers issued, 1997–98 to 2002–03

* The voucher system commenced in November 1997; the first full year of operation was 1998–99

Source: Office of Hearing Services data

Community Service Obligations

all Australians under 21 years of age;

clients with complex hearing rehabilitation needs;

eligible Aboriginal and Torres Strait Islander peoples; and

clients who live in remote areas of Australia.

The needs of these clients are met through Community Services Obligations delivered by Australian Hearing. The Australian Hearing Services Act 1991 requires Australian Hearing to provide these services. In 2002-03, 38,888 clients received services from Australian Hearing under CSOs. Australian Hearing also provides services to voucher clients, in competition with private providers, but these are not subsidised under the CSO arrangements.

Source: Office of Hearing Services data

Eligible Aboriginal and Torres Strait Islander Peoples

Hearing services are delivered to eligible Aboriginal and Torres Strait Islander peoples at either an Australian Hearing centre or through the Australian Hearing outreach program depending on which is the most convenient for the client. The outreach program is known as Australian Hearing Specialist Program for Indigenous Australians (AHSPIA). The focus of AHSPIA is on providing tertiary level services, namely a full diagnostic hearing assessment and supply including fitting of hearing devices if appropriate. Australian Hearing also provides hearing health advice in relation to prevention, community awareness and education.

Eligible Aboriginal and Torres Strait Islander adults also have the option of applying for a voucher and receiving services from any contracted service provider. In 2002-03 there were 1,814 Aboriginal and Torres Strait Islander clients seen by Australian Hearing under CSOs compared with 1,799 in the previous year. These clients often receive more than one service in any one year.⁹⁷ As a portion of total CSO clients4.7 per cent identified as Aboriginal and Torres Strait Islander peoples in 2002-03.

Clients with Complex Hearing Rehabilitation Needs and Australians Under 21 Years of Age

Children under the age of 21 and complex clients (for example, those clients with a hearing loss of greater than 80 decibels) are also assisted by Australian Hearing under the CSOs. Services to these clients are delivered by Australian Hearing at 73 permanent sites and approximately 200 visiting sites across Australia. In 2002-03 these clients represented 28 per cent of clients who received services under CSOs.⁹⁸

Research Activities

The Commonwealth Hearing Services Program also contributes to research undertaken by the National Acoustic Laboratories (NAL), the research arm of Australian Hearing, into factors related to hearing loss, hearing rehabilitation and the harmful effects of noise. This activity is also funded as a CSO for the Australian Government owned provider.

NAL conducted research for hearing in the following areas: assessment, hearing loss prevention, rehabilitation procedures and rehabilitation devices.

Research results were published in scientific journals and disseminated at scientific conferences, presentations to consumers, and professional continuing education programs for clinicians.⁹⁹ Further information is available at the NAL website .

One highlight of the research outcomes for the year was the investigation into the effectiveness of sound-field amplification systems in the classroom. These systems enable hearing impaired children to receive an amplified, less reverberant sound without restraining the mobility of the teacher. The number of educational skills (reading, writing and number) acquired by the children was 40 per cent higher during the semester in which the amplification was present compared to the other semester.

During the year there was increasing evidence of clinical take-up worldwide of an important recent NAL finding: people with a cochlear implant in one ear benefit from wearing a hearing aid in the other ear. Previously, it had been common practice for clinicians to recommend against the wearing of a hearing aid in the opposite ear but several NAL studies have indicated that the hearing aid helps with localising sound, understanding speech, and general functioning.

Funding for the Voucher System and Community Services Obligations

The introduction of the Hearing Services voucher system in 1997 has enabled more eligible clients to access the Commonwealth Hearing Services Program each year. Voucher system expenditure in 2002-03 was $156 million compared to $134 million for the previous year and $71.9 million at the commencement of the voucher system in 1997-98.⁷

Funding provided to Australian Hearing in 2002-03 for CSOs and research was $28.963 million compared to $28.182 million for the previous year and $26.202 million in 1997-98.¹⁰⁰

Information for Program Clients

The Office issues a comprehensive range of client information brochures to enable eligible clients to access, understand and participate successfully in the Commonwealth Hearing Services Program. In 2002-03 the Office developed a consolidated brochure containing comprehensive client information about the program.

All program information pamphlets and brochures are available electronically on the Office’s website at .

In 2002-03 the Office conducted a review of the Local Service Provider Directory which is provided to clients when they are issued with a voucher. As a result of this review, the Office has trialled the revised Local Service Provider Directory, which advised clients of the nearest hearing sites to their postal address rather than all the sites in their particular state.

Figure 6.3: Actual administered expenses for the Commonwealth Hearing Services Program, 1997–98 to 2002–03

Source: Office of Hearing Service data

Hearing Devices

As at 30 June 2003, 95,000 hearing device fittings (both monaural and binaural fittings) were provided to eligible clients. Also, a total of 1,097 types of hearing devices were approved for supply, including 512 available free to the client and 585 available as top-up devices.

The wide range of quality hearing devices available free to clients through the program provides a satisfactory hearing rehabilitation outcome to meet the assessed clinical needs of the majority of eligible clients. However, clients may choose to ‘top-up’ to more expensive hearing aids with additional features by paying the difference in cost between the Australian Government-provided benefit and the more expensive hearing aid.

Major Projects

Review of Clinical Standards

The Office commenced a review of the Clinical Standards it requires for service delivery to clients of the Commonwealth Hearing Services Program. The goal of the review is to develop client-focussed outcome standards, which are less prescriptive in nature; allow greater recognition of professional expertise; and are more aligned to international requirements for the provision of allied health services.

Following a select tender process, the Office signed a contract in February 2003 with Joint Accreditation System of Australia and New Zealand to undertake the review. The review is scheduled to be completed in late 2003.

Services to Eligible Aboriginal and Torres Strait Islander Peoples

In November 2002 the Report into Commonwealth Funded Hearing Services for Aboriginal and Torres Strait Islander Peoples: Strategies for Future Action was released by the Department with endorsement of the Minister for Health and Ageing, Senator the Hon Kay Patterson and the Minister for Ageing, the Hon Kevin Andrews MP. In response to the report, the Office is working in conjunction with the Office of Aboriginal and Torres Strait Islander Health (Outcome 7) to develop a work plan to address the recommendations of the report.

Outcome 6—Financial Resources Summary

PART 2: PERFORMANCE INFORMATION

Performance Information for Administered Items

1. 
   Provision of services for contestable clients, including:
   

those in receipt of a pensioner concession card, Department of Veterans’ Affairs Gold and White Repatriation (specifically for war related hearing loss) card holders, their dependants; and CRS Australia program participants, Sickness Allowees, and Defence Force personnel.

Measure	Result
Quality: The extent to which client satisfaction levels with hearing services are maintained or improved compared to the last client satisfaction survey (i.e. 96% very satisfied or satisfied).	The results of the summary survey for 2002-03 indicated that 96% of respondents were satisfied or very satisfied with the quality of service delivered by their chosen provider.
Quantity: All eligible clients who apply for a voucher receive one (estimated to be in the range of 130,000-140,000 vouchers this financial year).	In 2002-03 Hearing Services Vouchers were issued to 160,918 clients whose eligibility had been verified by Centrelink or DVA.
Efficiency: Maintain the existing average unit cost per voucher.	For 2002-03 the average unit cost was $752 per voucher compared to $732 in 2001-02.
Maintain the existing average maintenance liability.	The average maintenance liability for 2002-03 was $127 compared to $122 in 2001-02.

Provision of Community Service Obligations:

client services (mainly people under 21); and

Measure	Result
Quality: The quality of services delivered to match or exceed present levels.	Australian Hearing provided services in accordance with the Service Level Agreement. The Service Level Agreement is currently undergoing a mid term review.
Quantity: The number of services delivered to match or exceed present levels. Approximately 46,000 people under 21 receiving hearing services in 2000-01).	In 2002-03 there were 47,152 services delivered to children and adults under 21 years of age compared to 48,783 the previous year. Australian Hearing attributed these results to increasing number of hearing assessments undertaken by other agencies.
Efficiency: Average activity cost (including amortised infrastructure cost) for each client category to be maintained.	Australian Hearing has advised that they did not wish to provide average activity cost for each client category, given the feasibility study currently underway, which is reviewing competition issues in the Hearing Services Program.

research into hearing impairment, hearing rehabilitation and the harmful effects of noise.

Measure	Result
Quality: Complete approved research projects to a high standard. That is, number accepted for publication in peer-reviewed journals to be maintained.	A total of 31 scientific publications were accepted or published during the year compared to 23 last year.

Performance Information for Departmental Outputs

1. 
   Policy advice in relation to:
   

funding arrangements for the voucher system and Community Service Obligations;

enhancements to quality assurance arrangements;

the impact of new hearing aid technology on the program; and

other Hearing Services Program policy-related issues that arise from time to time.

Measure	Result
Quality: A high level of satisfaction of the Ministers, Parliamentary Secretary and Ministers’ Offices with the relevance, quality and timeliness of policy advice, Question Time Briefs, Parliamentary Questions on Notice and briefings.	There was a high level of satisfaction with the advice provided by the Office of to the Ministers’ office.
Agreed time frames are met for responses to ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefing.	Agreed time frames were met for: 96% of ministerial correspondence; 100% of Question Time Briefs; 100% of Parliamentary Questions on Notice; and 60% of ministerial requests for briefing.
A high level of stakeholder satisfaction with the quality and timeliness of departmental/portfolio inputs to national policy, planning and strategy development and implementation.	Measure met. The Office contributed to the Hearing Services Advisory Committee meetings and conducted regular meetings and discussions with Australian Society of Audiologists, Australian College of Audiology and the Deafness Forum of Australia. These stakeholders reported a high level of satisfaction with their interactions with the Office.
A high level of stakeholder satisfaction with relevance, quality and timeliness of information and education services.	During 2002-03 the Office identified the need to review the provision of information to service providers. A written survey was undertaken of a representative sample comprising service providers, practitioners and their representative peak body organisations. The survey indicated that there was a high level of satisfaction with, and use of, most of information products but some could be improved. The Office is implementing many of the recommendations of this review.
Timely production of evidence-based policy research to inform and engage stakeholders in meaningful policy and program discussions.	Measure achieved through National Acoustics Laboratories research. Information was delivered through the presentation of 33 presentations at public conferences and seminars. Also, stakeholders were involved in discussions regarding potential changes to Clinical Standards and Professional Qualifications.
Quantity: 180-220 responses to ministerial correspondence, 5-20 Question Time Briefs, 5 Parliamentary Questions on Notice and 5-10 ministerial requests for briefing.	There were approximately: 141 items of ministerial correspondence items processed; 6 Question Time Briefs prepared; 1 response to a Parliamentary Question on Notice; and 5 ministerial briefings prepared.

Program management, including:

program evaluation and monitoring;

developing, negotiating and managing contracts for provision of hearing aids and hearing services;

the payment of service providers by the Health Insurance Commission; and

financial management and reporting on Outcome 6.

Measure	Result
Quality: A high level of stakeholder satisfaction with the timely development and implementation of national strategies.	Overall a high level of stakeholder satisfaction was achieved, with the exception of some complaints raised by service providers in response to the changes made to the Local Area Directory.
Budget predictions are met and actual cash flows vary less than 5% from predicted cash flows.	Budget predictions and cashflow varied by approximately 5%.
Payments are made accurately and on time or payments are made in accordance with negotiated service standards.	Measure met.
A high level of stakeholder satisfaction with relevance, quality and timeliness of information and education services.	Measure met.
Quantity: Up to 137 Service Provider contracts and 16 Deeds of Standing Offer for device supply serviced.	As at 30 June 2003 there were 142 Service Provider Contracts and 15 Deeds of Standing Offer for device supply serviced.

Regulatory activity, including:

accrediting hearing aid manufacturers to supply hearing devices under the program;

accrediting service providers for the provision of hearing services under the program;

assessing hearing devices for approval for supply under the program; and

conducting audits and following up on complaints to ensure compliance with:

the Terms and Conditions in Service Provider Contracts and Deeds of Supply for hearing devices;

hearing device standards;

Rules of Conduct;

Clinical Standards; and

Advertising Rules.

Measure	Result
Quality: Evaluation of manufacturers for accreditation within two weeks of the manufacturer submitting all necessary information.	Measure met.
Evaluation of service providers for accreditation within two weeks of the provider submitting all necessary information.	95% of service provider applications for accreditation were evaluated within two weeks.
Evaluation of new devices against quality standards completed within two weeks of manufacturers providing all necessary information.	Measure met.
All applicants for a Hearing Services Voucher have eligibility checked through Centrelink or the Department of Veterans’ Affairs, whichever is applicable.	Measure met. During 2002-03, 1,448 applications were rejected due to lack of eligibility.
All providers adhere to the terms and conditions of the Service Provider Contract.	Site audits and client records management reviews are undertaken on a sample of service providers and qualified practitioners each year to check compliance with the terms and conditions of the Service Provider Contract. Feedback was given in all instances of non- compliance with the contract. The vast majority of providers met all requirements.
All providers comply with Rules of Conduct, Clinical Standards and Advertising Rules.	Compliance with the rules of conduct and clinical standards is tested through site audits and client record management reviews. Action was taken against eight service providers for breaches of compliance with the Rules of Conduct, Clinical Standards and Advertising Rules.
Quantity: Minimum of 40 site audits conducted by Office of Hearing Services within the Contract period.	There were 27 site audits conducted in 2002-03. The minimum of 40 represents number of audits to be conducted within a two-year contract period (from 1 July 2002 to 30 June 2004).
20% of all practitioners have client files reviewed annually.	Measure met. More than 21% of all practitioner files were reviewed in 2002-03.
Approximately 100 devices per year are evaluated (subject to number of requests for evaluation and approval submitted by manufacturers).	There were 200 devices evaluated in 2002-03.

Agency specific service delivery, including:

the issuing of vouchers and information to clients;

resolution of client and service provider complaints; and

direct provision of information and manual claim services to service providers.

Measure	Result
Quality: All vouchers to be issued within 14 days of receipt of a correctly completed application.	On average, clients were issued with a voucher around four weeks after receipt of a correctly completed application. The increased processing time was due to an increase in the number of vouchers issued and delays by Centrelink in processing applications.
High level of client satisfaction with services provided by the service provider.	The results from the client satisfaction survey for 2002-03 indicate that 96% of respondents were either satisfied or very satisfied with the quality of service delivered by their chosen provider.
Quantity: All eligible clients who apply for a voucher receive one (estimated to be in the range of 130,000-140,000 vouchers this financial year).	Measure met. In 2002-03 Hearing Services Vouchers were issued to 161,000 clients whose eligibility had been verified by Centrelink and DVA.
Quality: Client and other complaints resolved within an average of 10 working days of receipt of the complaint.	The average number of working days taken to resolve a complaint was 6.8.
Quantity: Number of complaints against 2000-01 benchmarks (670 complaints in 2000-01).	The Office of Hearing Services received 1,346 complaints in 2002-03. There was a 16% increase in complaints this financial year compared with a 12% increase in the number of vouchers issued. The main four areas of complaint were the quality of the service provided by hearing services providers (55%), service provider attitude (14%), issues around top up devices (11%) and the Office of Hearing Services (5%). The main issues complained about in relation to the Office were the time taken to issue vouchers, people not accepting that they were not eligible for the program and clients wanting new hearing aids without a clinical need to justify it. The increase in complaints can in part be explained by the Office’s continuing emphasis on information and educating clients about their rights and expectations. This has included producing and distributing a revised Service Charter for the Office as well as providing clients with updated and expanded information as part of their voucher pack. In addition, the Client Services Information Line has a role in educating clients about their rights and responsibilities when they inquire or complain about the program or their service provider.

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