THE COST OF BLINDNESS IN NEW ZEALAND
Everyone involved in the blindness community knows that being blind or vision-impaired is
expensive for individuals, families and society – in actual costs, time costs and opportunity costs.
But determining the cost of blindness is like asking how long a piece of string is.
No-one
anywhere in the world has come up with the perfect, undisputed research on the cost of blindness.
It is just too complex.
Against that backdrop, we are delighted to make public the most comprehensive research ever
done in New Zealand on the Cost of Blindness.
This research was conducted by Gravitas
Research and Strategy Ltd and Market Economics Ltd. Further analysis was done by Dr Jonathan
Godfrey, Lecturer in Statistics, Massey University, and graduate student Deborah Brunning. Both
reports are available on our website (www.rnzfb.org.nz) and in accessible formats through our
library.
As I mentioned above, no research on the cost of blindness is perfect. Budget constraints meant
our research included interviews with 200 of our approximately 11,500 members. Because of this
relatively small sampling, care must be taken in “over-interpreting" the results, or extrapolating
them onto other groups.
Total figures in the "Gravitas" report cannot be used to derive a
meaningful average cost per individual blind person - the range of actual incurred costs is simply
too wide. Finally, the Gravitas research focuses on actual costs of blindness, not opportunity costs.
The RNZFB and the Association of Blind Citizens (NZ) Inc will use this ground-breaking research
to inform Government and other stakeholders. It is our fervent hope that others build on this
research over time, so that the world can improve its understanding of the myriad and enormous
costs of the unique disability that is blindness.
Paula Daye
CEO
Royal New Zealand Foundation of the Blind
RESEARCH REPORT
Prepared By
Gravitas Research and Strategy Ltd
And
Market Economics Ltd
THE COST OF BLINDNESS
IN
NEW ZEALAND
FINAL REPORT
Prepared For
PUBLIC RELEASE MARCH 2006

Report completed by Gravitas Research and Strategy Ltd and Market Economics Ltd
December 2004

Analysis work undertaken or commissioned by the
Royal New Zealand Foundation of the Blind
and the
Association of Blind Citizens (NZ) Inc
during 2005

Public release March 2006
TABLE OF CONTENTS
ACKNOWLEDGMENTS
EXECUTIVE SUMMARY
1.
INTRODUCTION ...................................................................................................... 1
1.1
Background .............................................................................................................. 1
1.2
Research Objectives................................................................................................. 1
2.
1.2.1 Epidemiology and Prevalence of Blindness ................................................... 1
1.2.2 Individual Costs of Blindness ......................................................................... 1
1.2.3 Societal Costs of Blindness ........................................................................... 2
RESEARCH METHODOLOGY ................................................................................. 3
2.1
Examining the Costs of Blindness ............................................................................. 3
2.2
2.1.1 Life Stage and Timing .................................................................................... 3
2.1.2 Level of Adaptation ........................................................................................ 4
2.1.3 Level of Aspiration ......................................................................................... 4
2.1.4 Separating Wants and Needs ........................................................................ 4
2.1.5 Level of Support ............................................................................................ 4
2.1.6 Geographical Location ................................................................................... 5
Responses to the Research Challenges ................................................................... 5
2.3
Definitions Used ....................................................................................................... 6
2.4
2.3.1 Blindness and Vision Impairment ................................................................... 6
2.3.2 Costs of Blindness ......................................................................................... 6
2.3.3 Individual Direct Costs ................................................................................... 6
2.3.4 Individual Opportunity Costs .......................................................................... 7
2.3.5 Societal Costs of Blindness ........................................................................... 7
Research Methodology ............................................................................................. 8
2.5
2.4.1 Review of the Research Literature ................................................................. 8
2.4.2 Secondary Data Review ................................................................................ 9
2.4.3 In-depth Interviews ........................................................................................ 9
2.4.4 Focus Groups ................................................................................................ 9
2.4.5 Telephone Survey........................................................................................ 10
Survey Data Analysis .............................................................................................. 12
2.6
2.5.1 Data Weighting ............................................................................................ 12
2.5.2 Estimating Costs .......................................................................................... 12
2.5.3 Cost Calculations ......................................................................................... 13
2.5.4 Cost Allocation ............................................................................................. 13
Methodology Limitations ......................................................................................... 13
2.6.1 Survey Methodology .................................................................................... 13
2.6.2 Additive Effect of Other Disabilities .............................................................. 14
2.7
2.6.3 Limited Evaluation of Indirect Service Related Costs ................................... 14
2.6.4 Sampling Limitations.................................................................................... 14
2.6.5 Education Related Costs ............................................................................. 15
2.6.6 Comparisons in Time Spent Undertaking Activities ...................................... 15
Report Structure ..................................................................................................... 15
3.
LITERATURE REVIEW .......................................................................................... 17
3.1
Introduction ............................................................................................................. 17
3.2
Defining “Costs of Blindness” .................................................................................. 17
3.3
Previous Costs of Blindness Studies ...................................................................... 18
3.4
Individual Costs of Blindness .................................................................................. 19
3.5
3.4.1 Communication ............................................................................................ 19
3.4.2 Daily Living .................................................................................................. 20
3.4.3 Accommodation ........................................................................................... 20
3.4.4 Shopping ..................................................................................................... 20
3.4.5 Transport/ Mobility ....................................................................................... 20
3.4.6 Parenting ..................................................................................................... 21
3.4.7 Social Costs................................................................................................. 21
3.4.8 Costs to Partners, Family, Friends and Carers ............................................ 22
Societal Costs of Blindness .................................................................................... 23
4.
WELFARE BENEFITS AND THE VISION IMPAIRED ............................................ 25
4.1
Welfare for the Blind - Historical Overview .............................................................. 25
4.2
Current Benefits Available ...................................................................................... 27
4.3
4.2.1 Work and Income New Zealand (WINZ) ...................................................... 27
4.2.2 Accident Compensation Corporation............................................................ 28
Provision and Economic Cost of Benefits Provided................................................. 28
5.
4.3.1 Invalids Benefit ............................................................................................ 28
4.3.2 The Blind Subsidy ........................................................................................ 30
4.3.3 Sickness Benefit .......................................................................................... 30
4.3.4 Sickness Benefit (Hardship) ......................................................................... 32
4.3.5 Disability Allowance ..................................................................................... 33
4.3.6 ACC Weekly Compensation ........................................................................ 33
4.3.7 Other Benefits.............................................................................................. 35
4.3.8 Benefit Summary ......................................................................................... 35
EPIDEMIOLOGY .................................................................................................... 37
5.1
Introduction ............................................................................................................. 37
5.2
Final Estimates of New Zealand Blind and Vision impaired Populations (June 2004)38
5.3
Projections of New Zealand Blind and Vision impaired Populations (2011 and 2021)39
5.3.1
5.3.2
5.3.3
5.3.4
Analysis Methods......................................................................................... 39
Scenario One – Low Estimate...................................................................... 39
Scenario Two – Medium Estimate ............................................................... 40
Scenario Three – High Estimate .................................................................. 41
6.
EDUCATION AND TRAINING COSTS ................................................................... 44
6.1
Education Status .................................................................................................... 44
6.2
6.1.1 Levels of Education ..................................................................................... 44
6.1.2 Costs of Blindness Related to Education ..................................................... 45
Individual Costs ...................................................................................................... 46
6.3
6.2.1 Time Costs .................................................................................................. 46
6.2.2 Financial Costs ............................................................................................ 48
6.2.3 Opportunity Costs ........................................................................................ 49
Society Costs - Education Related Subsidies, Services and Benefits ..................... 50
6.3.1 Education Services- Ministry of Education ................................................... 50
6.3.2 Vision Education Agency (VEA) ................................................................... 51
6.3.3 Homai National School for the Blind and Vision Impaired ............................ 51
7.
6.3.4 Visual Resource Centres (VRCs) and Resource Teacher Vision (RTVs) ..... 52
6.3.5 Tertiary Education Support .......................................................................... 52
6.3.6 Tertiary Education Commission ................................................................... 53
6.3.7 Support and Assistance Received ............................................................... 54
6.3.8 Summary of Education Costs....................................................................... 54
EMPLOYMENT ...................................................................................................... 56
7.1
Economic and Employment Status of the Disabled ................................................. 56
7.2
Economic and Employment Status of the Blind and Vision impaired ....................... 56
7.3
Barriers to Employment .......................................................................................... 58
7.4
Financial Costs of Employment............................................................................... 58
7.5
Opportunity Costs Related to Employment ............................................................. 59
7.6
Individual Costs ...................................................................................................... 60
7.7
7.6.1 Financial Costs ............................................................................................ 60
7.6.2 Time Costs .................................................................................................. 61
7.6.3 Opportunity Costs ........................................................................................ 62
Society Costs - Employment Related Subsidies, Services and Benefits ................. 65
8.
7.7.1 Support and Assistance ............................................................................... 65
7.7.2 Workplace Modifications .............................................................................. 66
7.7.3 Work Bridge ................................................................................................. 67
7.7.4 State Services Commission ......................................................................... 68
7.7.5 Summary of Employment Costs................................................................... 68
DAILY LIVING ........................................................................................................ 69
8.1
Communication....................................................................................................... 69
8.1.1
8.1.2
8.1.3
8.1.4
8.1.5
8.1.6
Communication Equipment .......................................................................... 69
Computer Software ...................................................................................... 71
Braille Equipment......................................................................................... 72
Other Equipment.......................................................................................... 73
Equipment Training...................................................................................... 74
Equipment Repair and Maintenance ............................................................ 76
8.2
8.1.7 Opportunity Costs ........................................................................................ 78
Domestic and Personal Tasks ................................................................................ 79
8.3
8.2.1 Time Costs .................................................................................................. 79
8.2.2 Support and Assistance Required................................................................ 82
8.2.3 Financial Costs ............................................................................................ 83
Shopping ................................................................................................................ 84
8.4
8.3.1 Shopping for Groceries ................................................................................ 84
8.3.2 Time Costs .................................................................................................. 86
8.3.3 Support and Assistance ............................................................................... 86
8.3.4 Financial Costs ............................................................................................ 87
8.3.5 Opportunity Costs ........................................................................................ 88
Housing .................................................................................................................. 90
8.5
8.4.1 Financial Costs ............................................................................................ 90
8.4.2 Time Costs .................................................................................................. 92
8.4.3 Opportunity Costs ........................................................................................ 92
Recreation Activities ............................................................................................... 93
8.6
8.5.1 Financial Costs ............................................................................................ 93
8.5.2 Support and Assistance ............................................................................... 94
8.5.3 Opportunity Costs ........................................................................................ 95
8.5.4 Recreation and Social Activity...................................................................... 97
Voluntary Work ....................................................................................................... 98
9.
8.6.1 Support and Assistance Required................................................................ 99
8.6.2 Summary of Costs Associated with Daily Living ......................................... 100
TRANSPORT AND MOBILITY.............................................................................. 103
9.1
Individual Costs .................................................................................................... 103
9.2
9.1.1 Financial Costs .......................................................................................... 103
9.1.2 Time Costs ................................................................................................ 105
9.1.3 Opportunity Costs ...................................................................................... 107
Societal Costs of Transport Related Benefits and Subsidies ................................. 108
10.
9.2.1 Total Mobility Scheme ............................................................................... 108
9.2.2 Public Transport Subsidies ........................................................................ 111
9.2.3 Summary of Costs Associated with Transport and Mobility ........................ 111
SOCIAL COSTS OF BLINDNESS ........................................................................ 112
10.1
Introduction ........................................................................................................... 112
11.
10.1.1 Loss of Independence ............................................................................... 112
10.1.2 Difficulties Achieving Social Integration ...................................................... 113
MEDICAL, ASSESSMENT AND SERVICE PROVISION COSTS ......................... 115
11.1
Individual Costs .................................................................................................... 115
11.1.1 Medical and Health Consultations .............................................................. 115
11.1.2 Medication and Drugs ................................................................................ 118
11.1.3 Secondary Health Conditions..................................................................... 119
11.2
Annual Numbers Seeking Treatment .................................................................... 120
11.3
Ministry of Health Costs for DHB Ophthalmology Services ................................... 124
11.4
Pharmaceutical Management Agency Subsidies for Eye Related Drugs............... 127
11.5
Disability Support Services ................................................................................... 127
12.
11.5.1 Summary of Costs Associated with Medical, Assessment and Service
Provision ............................................................................................................... 129
SUPPORT AND SERVICES NOT AVAILABLE .................................................... 131
12.1
Support Not Accessible ........................................................................................ 131
13.
ECONOMIC COSTS OF OTHER SERVICE PROVISION .................................... 133
13.1
RNZFB Services ................................................................................................... 133
13.2
13.1.1 Volunteer Services..................................................................................... 133
Postal Concession ................................................................................................ 133
13.3
Other Services ...................................................................................................... 134
14.
COST SUMMARY TABLES .................................................................................. 135
15.
REFERENCES ..................................................................................................... 142
ACKNOWLEDGEMENTS
The researchers would like to thank all those people who have contributed to the costs of
blindness research. The final research report represents not only the work of the research
team but also the collective effort of many people who have contributed time, experience
and expertise in making the research possible.
We would particularly like to thank the many Royal New Zealand Foundation of the Blind
(RNZFB) members who took the time to participate in the research. Your willingness to
honestly and critically examine the costs of blindness in your daily lives has been
fundamental to the research. Your courage, determination and tenacity inspired us all.
Particular thanks also to the parents of vision impaired children; your participation has
vitally informed understanding of how the costs of blindness impact beyond those with
vision impairment.
Thank you also to the key informants involved in the research. Your expertise and
experience of the costs of blindness provided the essential foundations for the research.
There are too many people to individually thank within the RNZFB. A collective
acknowledgement is necessary but unable to fully recognise the input of each individual.
We thank you all for your unfailing enthusiasm for the research and your willingness to
assist us in its completion.
There are many other individuals within many other organisations to thank. In particular,
we would like to acknowledge the assistance of personnel within the Vision Education
Agency, Statistics New Zealand, Ministry of Social Development, Auckland Area Health
Board, Ministry of Education, Ministry of Health, Workbridge New Zealand, Transfund New
Zealand, Local Government, Pulse Data International, New Zealand Radio for the Print
Disabled Inc. and Ophthalmology departments throughout the country.
EXECUTIVE SUMMARY
Introduction
The Royal New Zealand Foundation for the Blind (RNZFB) commissioned Gravitas
Research and Strategy Ltd and Market Economics Ltd to conduct research into the direct,
indirect and opportunity costs of blindness in New Zealand. To advance understanding of
both the individual and societal costs of blindness, three main research questions were
addressed:

how many blind and vision impaired people are there in New Zealand;

what are the quantitative and qualitative costs of blindness to the individual; and,

what are the costs of blindness to society?
The costs of blindness are defined to include financial, time and opportunity costs as well
as non-quantifiable qualitative costs. Individual costs are defined as extra, non-optional
costs incurred by blind and vision impaired individuals because of their blindness or vision
impairment. Costs are above and beyond those that would be encountered if the person
did not have vision impairment. Societal costs are defined as the costs to society to
provide the services, treatment, equipment, benefits and other support required to mitigate
the effects of vision impairment.
Costs are identified and reported purely on the basis that they exist and not on the basis
that they have been assessed as costs appropriately compensated for by the government.
The study provides greatest focus on quantifying the financial costs of blindness, whilst
also providing some qualitative discussion of costs to support the quantitative analysis.
The definitions of blindness and vision impairment used in the study are the same as
those used by the World Health Organisation (1997). Total blindness is defined as
anything less than visual activity of 3/60 but not including 3/60. ‘Low vision’ is defined as
anything less than 6/18 but not including 6/18. Throughout the report, the terms ‘blind’
and ‘vision impaired’ are used to distinguish between individuals defined as having total
blindness and those defined as having low vision.
In this research report the definitions of ‘individual’ and ‘society’ have been taken to
describe the following:

The individual is defined as including both the blind or vision impaired person and
his or her family;

Society is defined as including government, charitable organisations and persons
who fall outside the above definition of the individual, for example friends, flatmates
and neighbours.
Whilst family members have been included as part of the individual unit, distinction has
been made when discussing support and assistance. Throughout this report helpers have
been distinguished as those being members of the blind/ vision impaired person’s family,
defined as ‘family helpers’; those falling outside this definition are referred to as ‘society
helpers’. Society helpers will include a varied mix of individuals and organisations as
relevant to the specific area of research investigated, as such society helpers may include
flatmates, friends, neighbours, shop assistants, members of the public, transport workers,
workmates, employers, fellow students, volunteers, government aid (benefits, subsidies
and paid helpers) and so on as relevant.
Research Methodology
The research assesses the current and future incidence of blindness and vision
impairment in the New Zealand population and the individual and societal costs of
blindness. Identified costs are expanded to both the current and projected future
populations of blind and vision impaired individuals to provide population cost estimates.
The research data was collected through:

a review of the national and international literature on the costs of blindness;

an extensive review of secondary data sources;

eleven in-depth key informant interviews;

four focus groups with RNZFB members; and

a national telephone survey of 200 RNZFB members using Computer Assisted
Telephone Interviewing (CATI).
The research methodology was primarily designed to enable quantification of the costs
identified. In doing so, the study reports average costs for different sub-groups and
aggregates costs into two categories; those incurred by either the ‘individual or family’ or
‘society’. These costs are further differentiated as costs incurred by blind or vision
impaired persons. Average costs are reported per recipient to demonstrate the magnitude
of costs to those who incur them. Total costs are estimated for the blind and visually
impaired population (three estimates of this have been developed and these are
discussed in the next section).
In recognising the individuality of the costs of blindness, the study examines how costs
differ in relation to variables such as life stage, employment status, gender and location.
These are identified and discussed where statistically significant differences occur. For a
full set of tables which cover all variables, please see separate document: ‘The Cost of
Blindness in New Zealand Full Table Set’ (excel format). Analysis of cost differences at
the specific sub-group level, for example, between those in the prime working age years
and those in retirement years, enables identification of how the cost burden differs
between such groups.
The costs of blindness identified have not been discussed in terms of whether they do, or
do not constitute costs which are appropriately compensated for by government. The
study, has, however, sought to focus on the extra, non-optional costs which are incurred
as individuals seek to participate in society in the manner and extent to which any society
member should rightfully expect. In striving for such integration, the extent to which blind
and vision impaired individuals should personally incur subsequent costs clearly demands
further discussion.
Estimates of the Blind and Vision impaired Population
No one data source exists to estimate the total blind and vision impaired population in
New Zealand. Data is derived from a variety of sources, each providing different
estimates. Because of this, three estimates are presented:

A low estimate gives a current blind and vision impaired population of 11,293, this
being the total RNZFB membership in June 2004;

A medium estimate guided by leading NZ ophthalmologists gives a current
population of 12,000 blind and 34,700 vision impaired people; and

A high estimate provides a June 2004 equivalent to the estimated 98,400 New
Zealanders identified by the 2001 New Zealand Disability Survey estimated by
Statistics NZ.
Applying population forecasts to these three estimates gives projections for the blind and
vision impaired populations:

Under the low estimate, the blind population is projected to grow 36% from 3,200 in
2004 to 4,300 in 2021. During this same time, the vision impaired population will
reach 11,500, up 3,400 (42%) from 2004.

Under the medium estimate, the blind population will grow by 36% from 11,600 in
2004 to 16,000 in 2021. The vision impaired population will reach 44,600 in 2021,
up 10,000 (29%) from 2004.

Under the high estimate, the blind population will grow by 34% from 10,900 in 2004
to 14,600 in 2021. The vision impaired population will reach 113,000, up 25,000
(37%) from 2004.
Overview of Costs Identified
The direct financial costs incurred by the blind or vision impaired individual are shown to
be substantial. From the need to pay for assistance to undertake relatively minor
domestic and household tasks through to expenditure on adaptive equipment, these costs
are shown to be varied and unavoidable. Further indirect financial costs are also
identified. While unable to be quantified, these costs include difficulties faced in easily
and consistently purchasing cheaper grocery items and the need for housing which has
proximity to necessary amenities, services and other supports which can be more
expensive.
The discussions held in this research indicate that substantial time costs are incurred by
blind and vision impaired persons. Qualitative findings indicate additional time potentially
spent undertaking domestic and personal tasks, travel, study, and training are evident by
those who undertake these tasks unassisted. Qualitative findings also indicate that those
employed spend longer undertaking the requirements of their job and often travelling to
work if they use public transport.
Time costs are incurred in many ways: extra time spent undertaking activities; time spent
planning, scheduling and marshalling resources; time lost in not being able to do
something immediately, or in waiting for necessary assistance; time spent identifying,
accessing and asserting rights to available support and assistance.
Time costs also constitute a significant opportunity cost. While unable to be quantified,
the additional time spent undertaking daily living activities means less time for other
activities and endeavours.
Time costs are also shown to be substantial for those providing assistance to blind and
vision impaired individuals. These costs are particularly evident in areas such as the
undertaking of domestic tasks, travel, recreation and voluntary work participation. Much of
the time family members spend providing such assistance is unpaid and again constitutes
a significant opportunity cost.
While of less focus in the study, the research findings provide further understanding of the
range of opportunity costs faced by blind and vision impaired individuals. These costs
have not been quantified nor have attempts been made to attribute a dollar value to them.
Collectively, however, they illustrate the huge impact blindness and vision impairment has
on available options, choices and the level of independence possible. The cost of a loss
or reduction in autonomy, flexibility and spontaneity should also not be underestimated.
Consideration of manageability, accessibility and the availability of support can dominate
decision making, rather than preferences, convenience and appropriateness. Under such
consideration, qualitative findings indicate that opportunities may be more likely to be
forgone. Difficulties accessing information can also mean that opportunities are missed or
less likely to be considered.
Costs of Blindness
The following sections discuss the costs of blindness identified and where quantified in the
range of areas researched. The total costs reported are annual costs based on
depreciation of capital expenditures and grossing up of day to day expenses and time
costs. Costs include those incurred by individuals, their family and by society as captured
in the survey of Foundation members. Additional societal costs, such as the cost of the
Total Mobility Scheme, benefits and medical costs, also exist and, where possible, are
discussed in later sections.
Undertaking Domestic and Personal Tasks
Survey respondents commonly report requiring assistance to undertake domestic tasks
around the home. Family members providing this assistance are reported to provide an
average of 290 minutes of assistance each week. Almost all (95%) of these helpers are
unpaid. Society helpers provide an average of 174 minutes of weekly assistance, with
80% of these helpers being paid.
In total, 42% of survey respondents report that they or their family incur a personal
financial cost for domestic assistance received around the home. This cost is estimated at
an average of $75.24 per month.
Summary Table 1: Total Cost (to both Individual and Society) of
Domestic and Personal Tasks
Population Base Estimate
Cost Estimate ($000's)
Low Estimate (RNZFB Membership)
32,648
Medium Estimate (Ophthalmologists)
122,193
High Estimate (NZ Disability Survey)
246,705
Grocery Shopping
Survey respondents report an average of 143 minutes per week spent shopping for
groceries, with blind respondents spending on average an extra 42 minutes per week
shopping compared to vision impaired respondents. Over two thirds of respondents who
shop require assistance to do so. Family helpers provide an average of 116 minutes of
assistance per week, with most of this assistance identified as unpaid. Society helpers
provide an average of 67 minutes assistance per week.
Qualitative discussions also identify a lack of ability to be adhoc or spontaneous, resulting
in time spent and clear necessity for careful planning and arranging of shopping needs
and shopping trips.
Indirect financial costs related to shopping reported by participants include restricted
ability to take advantage of sales and specials and heightened difficulties accessing
cheaper goods generally. Reported opportunity costs include, fewer shopping trips than
desired, less purchasing choice, a more limited range of products generally purchased
and reliance on others to undertake or assist with shopping.
Summary Table 2: Total Cost (to both Individual and Society) of Grocery Shopping
Population Base Estimate
Cost Estimate ($000's)
Low Estimate (RNZFB Membership)
7,245
Medium Estimate (Ophthalmologists)
26,400
High Estimate (NZ Disability Survey)
57,000
Communication Equipment
Communication equipment commonly used includes magnifying equipment (75% of all
survey respondents), talking book players (65%), tape recording equipment (29%) and
personal computers (23%). Tape recording and magnifying equipment is most commonly
acquired through personal purchase while CCTV’s, talking book players and OCR
scanners are commonly acquired through loan, lease or given by someone else.
Forty two percent of computer users report using screen magnification software such as
Zoomtext and 33% report use of screen reader software such as JAWS.
Approximately, six percent of the survey sample report using Braille equipment, this
equates to approximately 600 foundation members. Braille-writers are reported to be
used by 52% of Braille users, while 41% of users use Braille embossers. Braille
embossers are most likely to have been purchased personally, although most commonly
with financial assistance or subsidy from society sources. More expensive Braille
equipment such as Braille Writers and electronic notetakers are mostly bought for, or
given by someone else, primarily by society sources.
Other communication costs identified include the loss of privacy due to requiring others to
read personal correspondence such as bank statements. Respondents also discuss
delays and the inconvenience of being unable to read information exactly when required
and a loss of privacy and independence in this context.
The cost of adaptive equipment is particularly significant given the increasing importance
and potential of adaptive technology to mitigate the disadvantages of blindness. Cost
barriers to accessing adaptive equipment or difficulties learning communication
technology can mean heightened reliance on others, more pronounced loss of
communication skills and reduced ability to remain connected and conversant within
society generally. In addition, access to and ability to use adaptive technology is
increasingly important in preparation for, and likelihood of, gaining employment.
Communication Equipment Training
Recipients of Braille training estimate an average of 39 days spent in training while
recipients of personal computer training estimate an average of 16 days training. Training
in adaptive software is also time consuming – recipients of screen reader software training
estimate an average of 12 days of training, while those undertaking screen magnification
software training estimate 13 days of training. While most respondents do not directly pay
for training received, the time and financial costs of travelling to and from training are
commonly identified. Time off work and lost income are also identified, however less
frequently.
Summary Table 3: Total Cost (to both Individual and Society) of Communication
Equipment (including training and maintenance)
Population Base Estimate
Low Estimate (RNZFB Estimate)
Cost Estimate ($000's)
6,232
Medium Estimate (Ophthalmologists)
28,000
High Estimate (NZ Disability Survey)
50,700
Transport and Mobility
Accounting for Total Mobility subsidies, the average reported weekly spend for blind and
vision impaired taxi users amounts to $15 per week. Expenditure for those 18 years or
less is significantly higher than average at $40 per week.
These findings do not suggest that expenditure on taxi use constitutes travel costs above
and beyond that which sighted equivalents would incur. Research participants also
recognise in not running and maintaining a vehicle, significant financial costs are avoided.
However, expenditure on taxis does not represent all travel undertaken or necessarily
indicate total satisfaction of travel needs, that is, the average spend on taxis by blind and
vision impaired users may be low because users simply cannot afford to spend more than
this. For twenty nine percent of the 18 to 65 year olds surveyed, cost is the main reason
for not taking taxis or not taking taxis more regularly. This finding suggests cost as a
constraint on the regularity or freedom within which travel is undertaken this is confirmed
in the qualitative discussions. While not examined in the study, such cost barriers may
also contribute further to costs experienced by others, for example, through increased
reliance on others for transport assistance. Indeed the research suggests that it is the
loss of travel independence which constitutes a significant transport related cost for blind
and vision impaired individuals.
Reliance on others for transportation is identified as a significant opportunity cost as well
as one resulting in substantial time costs. While not quantified, time can be lost waiting for
arranged transport or in needing to structure activities around available transport, for
example, public transport timetables. Planning and carrying out travel arrangements is
also seen as highly time consuming. Time spent travelling can also impact on time
available to undertake other activities.
Reliance on others for transport inevitably incurs financial and time costs for those
providing transport assistance. On average, family members providing this assistance
contribute an average of 126 minutes of assistance each week. Society sources such as
volunteer drivers are reported to provide an average of 112 minutes of travel assistance
each week. While not quantified, parents of vision impaired children also report
transportation comprising a significant time cost for them and one not envisaged to
diminish as their children grow older.
Summary Table 4: Total Cost (to both Individual and Society) of Transport and Mobility
(excluding travel to work or study)
Population Base Estimate
Cost Estimate ($000's)
Low Estimate (RNZFB Membership)
17,693
Medium Estimate (Ophthalmologists)
85,200
High Estimate (NZ Disability Survey)
172,400
Housing
Housing related costs identified include the need for additional safety features (24% of
respondents), contrasting features within homes (21%), additional or special lighting
(20%) and additional security features (14%). Participants also report less flexibility and
choice when choosing where to live, particularly because of the need for proximity to
amenities and support services. Some report this requirement resulting in higher housing
costs, with houses close to required amenities reported as generally being more
expensive.
Summary Table 5: Total Cost (to both Individual and Society) of Housing
Population Base Estimate
Low Estimate (RNZFB Membership)
Cost Estimate ($000's)
320
Medium Estimate (Ophthalmologists)
1,049
High Estimate (NZ Disability Survey)
2,425
Recreation
Patterns of recreation activities undertaken are illustrative of the functional limitations of
blindness. Compared to vision impaired respondents, blind respondents more commonly
undertake home-based, individual focused activities such as crafts, playing with pets,
reading and listening to talking books. Activities more commonly undertaken by vision
impaired respondents tend to be more public and social in nature, for example, voluntary
work, sports, socialising and attending movies, concerts and other performances. Vision
impaired respondents are also more likely to undertake activities requiring a higher level of
functional ability, for example, gardening, playing computer games, puzzles, games and
cards and undertaking DIY projects.
Half (51%) of the respondents undertaking recreation and leisure activities require
assistance from others to do so. This includes the need for guidance and assistance
during the activity undertaken and for transportation (both at 62%). Society helpers spend
an average of 124 minutes per week providing assistance, most of which is unpaid.
Family helpers spend an average of 239 minutes per week proving this type of assistance,
most of which is also unpaid.
Summary Table 6: Total Cost (to both Individual and Society) of Recreation
Population Base Estimate
Costs ($000's)
Low Estimate (RNZFB Membership)
8,445
Medium Estimate (Ophthalmologists)
37,300
High Estimate (NZ Disability Survey)
73,800
Opportunity costs include being unable to undertake recreational activities previously
undertaken, reduced choice in activities possible, reduced access to information about the
availability of events and activities and the possibility of avoiding certain activities simply
because of participation difficulties, for example, transport logistics. Parents of vision
impaired children report incurring time and money costs in order that their children are
able to participate in recreational and sporting activities that are appropriate and enjoyable
for them.
Education
Data from the 2001 New Zealand Disability Survey shows that in comparison to the total
New Zealand population, the share of blind and vision impaired adults with no
qualifications (30%) is higher than the national average (24%). The proportion of blind
and vision impaired population having attained school qualifications (25%) is also less
than the national average (34%). Approximately 28% of New Zealanders have post
school qualifications. This share is again significantly higher than the reported 4% for
blind adults and 17% for vision impaired adults.
Students identify many challenges in reaching their academic potential. The difficulty or
inability to use visual references such as graphs and diagrams is particularly noted. Past
research in this area notes that such difficulties can have the effect of restricting access to
certain subject areas and consequently higher paying career potential in the future.
All blind students and 75% of vision impaired students require some form of additional
assistance in order to complete the requirements of their study. Society helpers are
identified as providing 784 minutes of assistance each week.
Students estimate an average of 334 additional minutes spent studying each week
because of their blindness or vision impairment. Tertiary students report 570 additional
minutes per week, polytechnic students 480 minutes and secondary students 271 minutes
each week.
Parents of vision impaired children report significant time costs in ensuring their children
receive rightful access to education related support, adaptive technology and other
funding. Parents may feel compelled to purchase adaptive equipment themselves, for
example, computers, if it is felt that available government provision is not appropriately
timed to meet their children’s needs. Other reported financial costs include the cost of
constructing appropriate educational resources for use within the home and undertaking
training themselves in adaptive equipment so as to be able to provide learning assistance
within the home.
Summary Table 7: Total Cost (to both Individual and Society) of Education
Population Base Estimate
Estimated
students*
Population
of
Costs ($000's)
Blind/
VI
5,530
*A population base of 850 blind and vision impaired students (from primary through to
tertiary education) was calculated using information on the number of students as reported
by the Vision Education Agency (VEA) and an estimate of blind and vision impaired
tertiary students accessing disability support services at the University of Auckland. As
such, this figure cannot be extrapolated according to the low, medium or high population
estimates, due to a lack of linkage between the weight estimate of 850 and the population
base data.
Economic Status and Employment
A review of the national and international literature shows that compared to national
averages, blind and vision impaired adults have higher rates of unemployment and
underemployment, are more likely not to be in the labour force and more likely to be in
receipt of a government benefit.
Qualitative data derived in the study provides further support for previously identified
opportunity costs in relation to employment. Amongst other employment related issues
discussed, participants talk of reduced employment and career potential,
underemployment, as well as forgone or lost income.
The research also shows that, when employed, blind and vision impaired workers face a
number of employment related costs. Collectively, blind and vision impaired workers
report an average of 190 minutes spent travelling to and from work each week. Assuming
a five day week, this equates to 38 minutes a day travelling. By sub-group, blind workers
report an average 49 minutes travelling per day.
Employed respondents using taxis to travel to work report an average personal weekly
expenditure of $60.25 above any subsidies received.
Family members specifically driving workers to work reportedly spend an average of 287
minutes per week providing this assistance. Society drivers are reported to spend an
average of 160 minutes per week. Employed respondents required to travel within their
work report an average of 623 minutes of travel assistance provided to them each week.
Almost two thirds (64%) of employed respondents report requiring special assistance
within the workplace, the most commonly mentioned type being additional administration
or secretarial support. Blind workers requiring additional support report receiving an
average of 265 minutes support per week. Vision impaired workers report an average of
241 minutes per week.
Twenty percent of employed respondents also report modifications to their workplace in
order to accommodate their particular needs. These include changes to the layout of work
areas and additional or special lighting. Modified duties, modified hours and modifications
to job responsibilities are also reported.
While not quantified, employed participants also self-report having to spend more time
fulfilling the requirements of their jobs compared to sighted equivalents.
Summary Table 8: Total Cost (to both Individual and Society) of Employment
Population Base Estimate
Costs ($000's)
Low Estimate (RNZFB Membership)
6,922
Medium Estimate (Ophthalmologists)
49,975
High Estimate (NZ Disability Survey)
122,018
Health and Medical
Over half (52%) of survey respondents report they consulted an ophthalmologist in the
preceding 12 months. Other health professionals consulted for advice/treatment for
blindness or vision impairment include GP’s (33%), optometrists (29%), pharmacists
(25%), and podiatrists and chiropodists (25%).
Personal financial costs are most commonly incurred for consultations with GP’s (80% of
those consulting a GP), podiatrists and chiropodists (78%) and optometrists (64%).
The time spent travelling to medical consultations is also documented. Twenty percent of
provincial respondents consulting optometrists travel two to three hours for each
consultation. Thirteen percent of rural respondents travel one and two hours per
optometrist consultation while 9% travel more than three hours. For some respondents,
travel to ophthalmologist consultations is particularly time consuming. Sixteen percent of
those consulting ophthalmologists travel between one to three hours and seven percent
travel for more than three hours. Notably, 16% of rural respondents consulting
ophthalmologists travel more than three hours to do so.
When assistance other than drivers of taxis or public transport is required to attend
medical consultations and treatments, this is most likely to be provided by family helpers.
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).
Respondents incurring at least some personal cost through taking prescription drugs
because of their blindness or vision impairment report an average personal cost of
$204.47 a year for this treatment. Additionally, where costs are incurred by those taking
non-prescription drugs and those taking herbal remedies or vitamins, the average spends
are $81.08 and $138.25 a year respectively.
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. While not quantified, associated costs reported include: loss of
quality of life, time spent travelling to and from medical appointments, consultations with
medical professionals and rehabilitation.
Summary Table 9: Total Cost (to both Individual and Society) of Health and Medical
Population Base Estimate
Cost Estimate ($000's)
Low Estimate (RNZFB Membership)
2,767
Medium Estimate (Ophthalmologists)
9,714
High Estimate (NZ Disability Survey)
21,053
Social Costs
While not a primary focus within the study, two social costs commonly identified by
participants include the loss of independence and increased potential for social isolation.
Loss of independence occurs through lessened ability to undertake a range of activities as
well as increased reliance on others. Reliance on others can have further impacts on
family members, for example, reduced time available for other siblings and fewer
opportunities for parents of vision impaired children to have time-out.
Many barriers to achieving or maintaining social networks and relationships are identified.
Difficulties may range from restricted ability to identify appropriate recreation opportunities
through to the planning and logistics required to attend a group or activity. The inability to
initiate and maintain visual contact with others is identified as a major barrier to social
engagement and can lead to a withdrawal from social activities or a tendency to limit
social contacts to known friends and smaller environments.
Costs to Parents of Vision Impaired Children
While limited investigation was undertaken, the study provides some understanding of the
costs of blindness experienced by the parents of vision impaired children. Parents
inevitably strive to provide as best they can for their children and to do as much as
possible to mitigate and address disadvantages faced. In doing so, financial, time and
opportunity costs are inevitably incurred. Many of these costs are not reimbursable and
fall directly onto the parents themselves.
Societal Costs of Blindness
Provision of Welfare Benefits
Work and Income New Zealand (WINZ) and the Accident Compensation Corporation
(ACC) are the main government and quasi government providers of welfare assistance to
blind and vision impaired persons.
As at 27 June 2003, 799 people are estimated to be receiving the Invalid’s Benefit with
blindness as their primary disability. An annual cost of $9.6m at an average of $12,047
per recipient is estimated. A further 518 people are estimated to be receiving an Invalid’s
Benefit with vision impairment as the primary disability. A total annual cost of $6.3m at an
average of $12,202 per recipient, is estimated.
As at 27 June 2003, 8 people are estimated to be receiving the Sickness Benefit with
blindness determined as their primary disability. An annual cost of $73,700 at an average
of $9,216 per recipient, is estimated. A further 194 people are estimated to be receiving a
Sickness Benefit with vision impairment as the primary disability. The total annual cost of
this provision is estimated at $1.9m at an average of $9,626 per recipient.
In addition, 495 blind and 405 vision impaired recipients also receive a Disability
Allowance estimated to total in 2003, $689,000 and $398,000 respectively. Blind
recipients received on average $1,393 per annum and vision impaired recipients $984.
Collectively, Invalid, Sickness and Disability Allowance provision is estimated at
approximately $19 million per annum for blind and vision impaired recipients.
In 2002/03, there were 2,500 new claimants and 2,200 existing claimants to ACC
receiving financial assistance relating to eye injuries at a cost of $10.4m. Note: this
includes all severities and both permanent and temporary injuries.
Employment Support
It is estimated that Workbridge provided job placement support to blind and vision
impaired job seekers to the value of $1.2m between June 2003 and May 2004. Blind job
seekers are estimated to have on average received $5,964.50 of assistance during this
year and vision impaired job seekers $4, 605.62.
Other employment support services have not been quantified due to lack of access to or
presence of such information. Employment support possibly provided to blind and vision
impaired persons by their employers was covered in the survey of RNZFB members and
is included in this section of the report.
Transport and Mobility
In 2002, the total cost of the Total Mobility scheme servicing blind and vision impaired
users is estimated at $712,106.53. An average annual cost of $130.85 per blind or vision
impaired user is estimated, this comparing to an average annual cost of $192.16 for all
users. This figure has been derived based on research conducted by Transfund and
through contact with individual regional councils where gaps were identified.
Public transport subsidies for blind and vision impaired users would also likely incur some
cost to society; however, information on these users is not collected. In Auckland, bus
and train subsidies are provided to blind and vision impaired persons, allowing them to
travel at the senior citizens rate. As such, while the number of senior citizen fares can be
derived, distinction between blind and vision impaired users and senior users cannot be
made.
Health and Medical Treatment
Ministry of Health information on volumes of patient services contracted to District Health
Boards provides the best available estimate of the number of people seeking treatment
from ophthalmologists. This data, however, over-estimates the number of people seeking
treatment for blindness and vision impairment as it includes anyone treated for an eye
related issue, rather than just those meeting the definition of blindness or vision
impairment used in the study.
Approximately 46,000 events are budgeted for first time visits to ophthalmology clinics
throughout the 2003/04 financial year. A further 108,000 second visits are budgeted for
those as well as approximately 8,850 inpatient events. Total funding for Ophthalmology
department services and treatment over the 2003/04 year is estimated at approximately
$44 million.
In 2003, Pharmac spent $8.7m on drugs and $570,000 on prescriptions for eye and ear
related treatments. Figures again account for all eye related medications and treatments
and therefore over-estimate the cost of just treating blind and vision impaired individuals.
Disability Support Services
Available data on government funded Disability Support Services shows that there were
7,300 clients in 2002 and 8,700 clients in 2003 receiving support for sensory disabilities
which included both hearing as well as vision impairments.
Conclusion
The research reveals that the costs of blindness in New Zealand are wide ranging and
significant. Key cost areas are related to carrying out domestic tasks, day to day travel,
shopping, recreation and use of specialised equipment.
These costs are borne by individuals and their families and by society - though the
greatest burden currently lies with the individual and their families.
Qualitative discussions reveal visual conditions generating a number of opportunity costs
and also resulting in unrealised life potential in the economic and social areas.
Summary of costs quantified in the RNZFB Cost of Blindness Survey
The following table summarises the costs quantified in the survey of Foundation members
expanded to the three population scenarios. This table and tables throughout the report
do not include data collected from other secondary sources such as RNZFB costs,
government and council costs (in terms of subsidies or other costs) outside what was
reported by respondents in the RNZFB Costs of Blindness survey. These have not been
included because of the lack of information in terms of either detail or consistency (please
see separate document: ‘Data Collection Issues Encountered during the Costs of
Blindness Research’). As such, discussions of identified and accessible secondary
source information on societal costs are addressed throughout this report. No attempt to
collate or integrate this secondary source data with the information derived from the Costs
of Blindness Survey has been made due to issues as above.
Education costs are omitted as figures for the total blind and vision impaired populations in
education have not been able to be accessed by the research team. It is believed that
such information is able to be provided by the Tertiary Education Commission but was
unable to be provided for use in this research. In place of this a population estimate of
blind and vision impaired students totalling 850 (primary through to tertiary) has been
generated from information provided by the VEA and Disability Support Services at the
University of Auckland. This figure is in no way linked to the low (RNZFB), medium
(Opthamologists) or high (NZ Disability Survey) population estimates, thus education
costs are not presented here. Please see Section 6 for discussion of education costs.
Executive Summary Table: By cost area activity, Individual and Society according to Low, Medium and High Population Estimates.
Total Costs
Low Estimate (RNZFB membership)
Activity
Domestic tasks
Medium Estimate (Ophthalmologists)
High Estimate (NZ Disability Survey)
Cost to
Cost to
Total Cost
Cost to
Cost to
Total Cost
Cost to
Cost to
Total Cost
Individual
Society
($000’s)
Individual
Society
($000’s)
Individual
Society
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
24,035
8,614
32,649
93,448
28,745
122,193
197,837
48,869
246,706
Shopping
5,412
1,833
7,245
20,565
5,866
26,431
45,022
11,898
56,920
Misc. Equipment cost
1,705
1,619
3,324
6,656
7,297
13,953
14,202
14,956
29,158
64
598
662
246
2,622
2,868
488
4,706
5,194
Equipment – Braille
515
535
1,050
1,117
4,928
6,045
2,516
4,397
6,913
Equipment – other
227
74
301
832
288
1,120
1,759
560
2,319
Equipment training
251
155
406
623
1,205
1,828
1,081
1,512
2,593
392
97
489
1,534
669
2,203
3,219
1,309
4,528
13,583
4,111
17,694
64,120
21,027
85,147
126,406
46,015
172,421
300
20
320
957
92
1,049
2,216
209
2,425
4,767
3,678
8,445
16,778
20,564
37,342
37,350
36,459
73,809
Travel to work
688
46
734
2,734
203
2,937
5,684
462
6,146
Employment Related Travel
179
5,519
5,698
244
42,833
43,077
225
106,069
106,294
65
425
490
90
3,869
3,959
85
9,492
9,577
1,950
7
1,957
6,990
37
7,027
14,890
57
14,947
817
0
817
2,687
0
2,687
6,106
0
6,106
5,951
317
6,268
29,939
1,556
31,495
66,731
3,600
70,331
60,901
27,648
88,549
249,560
141,801
391,361
525,817
290,570
816,387
(excl shopping)
Equipment – computer
Equipment
repair/
maintenance
Travel (excl work travel)
Housing
Recreation
Education*
Work modifications
Medical
treatment/consultations
Medication
Voluntary work
TOTAL ALL ACTIVITIES
1.
INTRODUCTION
1.1 Background
The Royal New Zealand Foundation for the Blind (RNZFB) commissioned Gravitas
Research and Strategy Ltd and Market Economics Ltd to conduct research into the direct,
indirect and opportunity costs of blindness in New Zealand.
The need for the research arises from a comparative lack of local information on the costs
of blindness and the need for comprehensive information to inform RNZFB activities such
as funding and fund raising, advocacy, public awareness, service planning and service
delivery.
The research addresses three main questions:

how many blind and vision impaired people are there in New Zealand;

what are the quantitative and qualitative costs of blindness to the individual; and,

what are the costs of blindness to society?
In commissioning the research, the RNZFB recognises that blindness is a unique
disability, experienced in a world primarily structured around the visual senses. In posing
the specific research questions, it is recognised that deriving the true cost of blindness in
New Zealand requires consideration of the costs to the blind or vision impaired individual
as well as society as a whole. It is also recognised that while many costs of blindness can
be quantified and attributed a cost value, there are other, equally important qualitative and
non-quantifiable costs which also need to be acknowledged.
1.2 Research Objectives
The specific research objectives are as follows:
1.2.1 Epidemiology and Prevalence of Blindness
1. To determine the prevalence of blindness and vision loss in New Zealand by condition,
age, gender, location and ethnicity.
2. To estimate the prevalence of and trends in blindness and vision loss over the next 50
years.
1.2.2 Individual Costs of Blindness
3. To determine the quantitative (financial) non-optional costs of blindness to the blind or
vision impaired individual, including direct, indirect and opportunity costs.
4. To review the qualitative costs of blindness in areas such as mobility/transport,
communication, education, employment and recreation.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 1
1.2.3 Societal Costs of Blindness
5. To determine the costs of blindness to society in areas including: health; education;
transport; disability support services; government benefits, services and subsidies.
The study seeks primarily to identify the costs of blindness on the basis that they exist and
not on the basis that they are assessed as costs appropriately compensated for by the
government. There are likely to be different views on this issue, for example, whether
opportunity costs or expenditure patterns resulting from opportunity costs should be
compensated for. Making judgments on such issues is considered to be beyond the
scope of the current study, however, it is hoped the research findings will encourage
further discussion in relation to these issues.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 2
2.
RESEARCH METHODOLOGY
This section discusses the methodology used to undertake the costs of blindness
research. The section begins with a discussion of the challenges inherent in the research
and how the research approach has sought to respond to these. The definitions used in
the research are then discussed.
2.1 Examining the Costs of Blindness
It is recognised that the amount of functional sight does not always directly correlate with
the degree of impairment a blind or vision impaired person experiences (Kelly, 1995). A
range of social, psychological and physiological factors can affect how an individual reacts
to the loss of sight (Kelly, 1995). Factors can include an individual’s personality, degree of
vision loss, cause of blindness, age at onset and societal influences (Hudson, 1994).
Reflecting the above, it is also recognised that the costs of blindness at a personal level
can be diverse and highly individual (BCA, 2003; Chou, Misajon, Gallo & Keeffe, 2003).
There are many variables which are likely to influence if, when and to what extent an
individual may experience and recognise a cost as a cost of blindness. These can
include: the timing of the onset of blindness or vision impairment; lifestyle prior to onset
and the extent to which the previous lifestyle is restricted or limited; the amount of support
available to a blind or vision impaired individual; and, the extent to which costs may be
experienced or borne by those around them.
2.1.1 Life Stage and Timing
The timing of onset is likely to be a critical factor in the experience of the costs of
blindness. The cost structure and impact of these costs will likely differ by life stage and
costs will almost certainly change over a lifetime. For example, becoming blind or vision
impaired in the prime of one’s working life is likely to impose significant financial,
emotional and opportunity costs. Parents of a blind or vision impaired child are likely to
incur substantive costs during the up-bringing of their child with the distribution of the cost
burden possibly transferring more towards the individual as they age. If blindness or vision
impairment occurs later in life, it may become increasingly difficult to distinguish the costs
of blindness from other costs incurred by older aged persons generally. There is the
additional likelihood of other disabilities providing further difficulties teasing out respective
costs. Vision impairment at an older age may also be perceived or experienced as
resulting in fewer costs if changes in lifestyle are expected with age. Older age may bring
lower aspirations and expectations, further impacting on the experience of both direct and
opportunity costs.
The magnitude and impact of costs of blindness may also change over time. For
example, with technological advances, a significant cost ten years ago may now be
considerably reduced. However, technological advances may also bring new opportunity
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 3
costs. A blind or vision impaired person who today remains computer illiterate is likely to
face significant disadvantage and opportunity costs, for example, reduced employment
potential.
2.1.2 Level of Adaptation
The costs of blindness may also become less obvious to an individual with increasing
adaptation to vision impairment. For example, an individual blind from birth is likely to
have developed a higher level of adaptive functioning compared to an individual with more
recent vision impairment. Given this, the individual blind from birth is likely to have
become accustomed very early to many of the costs of blindness, likely making it more
difficult for costs to be recognised.
2.1.3 Level of Aspiration
The extent to which a blind or vision impaired individual aspires to be independent or to
achieve other accomplishments may also be influential in the experience and recognition
of the costs of blindness. If vision impairment impacts on an individual’s ability to satisfy a
goal, then the individual may rightly be defined as experiencing a cost of blindness.
For example, an individual striving to re-develop a level of independence after becoming
vision impaired may experience different costs compared to another individual who
accepts a lower level of independence. An individual may choose to become computer
literate as a means of enhancing independence, incurring a range of costs in the process
compared to an individual who may not pursue this goal. However, this decision may also
result in opportunity costs for this person, for example, reduced communication potential
and reduced employment prospects. Furthermore, this decision may also result in a
greater transfer of costs to others, for example, a greater reliance on others for
undertaking communication activities.
2.1.4 Separating Wants and Needs
The difficultly of separating ‘wants’ from ‘needs’ is a challenge when trying to measure the
costs of blindness. Both vision impaired and fully sighted people have ‘wants’, however, it
may be incorrect to count these ‘costs’ in the current study. Central to distinguishing
between the two is the concept of a cost being ‘non-optional’ (O’Neil, 2001). If, because
of their vision impairment, the blind or vision impaired person has no option but to incur a
cost in order to satisfy a need, this cost could rightly be determined a cost of blindness.
Comparisons to fully sighted people may also be useful in determining what costs are
‘non-optional’. If a cost is optional for a sighted person, but non-optional for a vision
impaired person, then this cost could be defined as a cost of blindness.
2.1.5 Level of Support
The presence or absence of a sighted partner may also impact on both the experience
and recognition of the costs of blindness. Adaptive functioning may be significantly
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 4
developed around the role of the sighted partner, thus reducing the personal experience of
costs by the vision impaired individual. Such situation is also likely to represent a transfer
of cost burdens to the sighted partner.
2.1.6 Geographical Location
While there is little available literature, the costs of blindness are also likely to be
influenced by geographical location, in particular urban or rural location. Relative
availability of, and access to, necessary services is likely to be influential in different cost
experiences.
2.2 Responses to the Research Challenges
An incidence-based costing approach is likely to have been most appropriate for capturing
the costs of blindness over time and how costs are likely to change over time. However,
this approach requires a level of detail on epidemiology and the long-term course of eye
diseases beyond the resources of the current study. The research has instead used
prevalence based costing which estimates the costs of blindness in a given time interval.
This approach does not explicitly account for when a person became blind or vision
impaired or the stage of disease progression. It does, however, assume that in deriving
costs from a representative sample of blind and vision impaired people that the costs
identified will accurately account for the distribution and range of costs experienced in the
whole population of blind and vision impaired people. These costs have been annualised
in the final analysis.
While utilising mean or average costs to extrapolate the costs identified through the
survey, the report also seeks to present the range of costs in order to acknowledge the
individuality of costs experienced.
To further understand costs by life-stage, the research examines costs by relevant
demographic characteristics such as age, gender, and employment status. Difference in
costs according to these demographic differences is reported and discussed where
statistically significant differences occur. A full set of tables is also provided in the
appendices for information according to demographic characteristics (age, sex, location,
and blind/VI). Focus group discussions were also arranged by life stage to enable more
in-depth examination of similarities and differences in costs by life stage.
A number of strategies were used in the costs of blindness survey to counter likely
differences in respondents’ experience and recall of costs. Throughout the recruitment
process, respondents were provided with definitions of possible costs of blindness,
including the range and types of costs likely to exist. To enable preparation for the
interview, each respondent was sent further information on the range and types of costs
and was encouraged to consider costs they may be consciously or unconsciously
experiencing. In particular, emphasis was placed on discussing costs as being nonoptional.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 5
2.3 Definitions Used
2.3.1 Blindness and Vision Impairment
The definitions of blindness and vision impairment used in the current study are the same
as those used by the World Health Organisation (1997).

Total blindness is defined as anything less than visual activity of 3/60 but not
including 3/60.

‘Low vision’ is defined as anything less than 6/18 but not including 6/18.
Throughout the report, the terms ‘blind’ and ‘vision impaired’ are used to distinguish
between individuals defined as having total blindness and those defined as having low
vision.
2.3.2 Costs of Blindness
The individual costs of blindness are understood as those extra, non-optional costs
incurred by blind or vision impaired persons because of their blindness or vision
impairment. These costs are above and beyond those that would be encountered if the
person did not have vision impairment.
The ‘individual’ for the purposes of the current study is defined as including not only the
blind or vision impaired person, but also members of the blind or vision impaired person’s
family. The reasoning behind such a definition is to recognise the impact of blindness or
vision impairment beyond the affected person to the family unit.
The societal costs of blindness are defined as the costs to society to provide the services,
treatment, equipment, benefits and other support required to mitigate the effects of vision
impairment.
‘Society’ is defined as including both local and central government agencies, charitable
and voluntary organisations and individual members of society outside of the blind or
vision impaired person’s family and may include flatmates, friends, neighbours,
workmates, employers, fellow students, shop assistants and member of the general
public.
2.3.3 Individual Direct Costs
At the individual level, the costs of blindness impact on the vision impaired person and
their family. For this reason, as discussed above, the study defines individual costs to
also include the costs incurred by immediate family members.
The individual costs of blindness are broken into further categories as follows:
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Direct Costs – Type 1: Money and time costs incurred for medical treatment and
mitigation of vision impairment and blindness. This includes specialist visits, medication,
surgery, sensory aids, artificial eyes and other equipment. It also includes travel
associated with medical appointments.
Direct Costs – Type 2: Money and time costs arising from impediments of undertaking
routine daily activities. Extra costs of daily activity include all costs associated with travel
and additional equipment and assistance with daily living.
2.3.4 Individual Opportunity Costs
Opportunity cost defines cost in terms of an opportunity foregone and the benefits that
could be received from that opportunity, or the most valuable forgone alternative
(Wikipedia 2004). In relation to blindness and vision impairment, opportunity costs can
include the extra time spent undertaking activities, for example, as well as the inability to
undertake an activity immediately as desired and the planning, scheduling and
marshalling of resources required to do something. Opportunity costs can also include
things that are missed out on, things that are selectively excluded or not pursued and the
need to concentrate lifestyle and activities around areas of life that are achievable.
Individual opportunity costs of blindness are broken into further categories as follows:
Type 1 Opportunity Costs: The range of costs incurred by blind or vision impaired
individuals and household members, because of the time involved in compulsory activities
and/or caring for vision impaired people, to undertake discretionary daily activities. The
direct effect is on time available, the consequent cost related to their quality of life.
Type 2 Opportunity Costs: The costs incurred by blind or vision impaired individuals
and household members who are unable to participate in some routine activities because
they do not have enough vision to do so. This will directly impact the vision impaired
individual and quality of life of other household members.
Type 3 Opportunity Costs: The costs to blind or vision impaired individuals and
household members from lower earning power than equivalent people who are not blind
or vision impaired. The direct effect is less money to buy goods, services and participate
in activities. The consequent effect is on the individual and household quality of life.
2.3.5 Societal Costs of Blindness
The societal costs of blindness are defined as the costs to society to provide the services,
treatment, equipment, benefits and other support required to mitigate the effects of vision
impairment. Societal costs also include the time inputs of volunteers and other agencies
in providing services to the blind and vision impaired.
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Societal costs of blindness are broken into further categories as follows:
Direct – Type 1: Public funding and subsidies for medical and equipment costs
associated with vision impairment. This includes funding by government and vision
impairment agencies.
Direct – Type 2: Money and time costs associated with supporting blind and vision
impaired people to undertake routine daily activities. This includes travel subsidies,
employment benefits, funding of education and employment training, postal concessions
and volunteer support.
Societal Opportunity Costs: While not examined in depth, societal opportunity costs
include that which is lost to society as a result of blindness and vision impairment. This
includes for example, talented blind people having to live in another country in order to
fulfil employment potential, blind people not being able to fully contribute to society, and
blind people not being more visible in the community. These costs can also include that
which is lost because of public perceptions of blindness, for example, an employer’s
expectation about the level of performance possible from a vision impaired worker.
2.4 Research Methodology
The components of the research are:
1.
Literature review (separate ‘summary’ and ‘by document’ reports available but not
included here)
2.
Review and analysis of available secondary data
3.
In-depth interview discussions with key informants
4.
Focus groups with RNZFB members
5.
Telephone survey of RNZFB members
The study draws on secondary and primary data sources as well as both qualitative and
quantitative research methodologies. Further description of method is provided below.
2.4.1 Review of the Research Literature
A review of the national and international literature on the costs of blindness was
undertaken.
Key words, structured around the objectives of the study, were used to conduct literature
searches through the following data bases and other sources: JSTOR, EBSCO Host,
Index New Zealand (INNZ) and Te Puna, Expanded Academic, Web of Science, Medline,
Digital Dissertations and the RNZFB library resources.
A broad range of relevant research reports and other documents were identified. Key
findings from each study were reviewed, documented and then further compiled under key
headings with particular relevance to the current study. Findings are reported in Section
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Three and as relevant, drawn on throughout the report. Separate Literature Review
documents are available, both an overall literature summary document and a by article
review document have been completed as part of the research.
2.4.2 Secondary Data Review
A range of secondary data was sourced and reviewed, particularly to inform analysis of
epidemiology and the societal costs of blindness. The following data was reviewed:

RNZFB Annual Reports and Financial Statements

ACC Annual Reports and Financial Statements

MSD Annual Reports

RNZFB Membership Database

Statistics NZ Census (2001)

Statistics NZ Population Forecasts

Disability Survey

Statistics NZ Disability Survey

Statistics NZ Time Use Survey
2.4.3 In-depth Interviews
Eleven in-depth interviews were conducted with key informants to provide understanding
of key issues for the research and to inform development of the final research design
(refer to Appendices for Interview Schedule).
Key informants were identified by the RNZFB as having expertise in the costs of blindness
as well as other areas with relevance to the study. These areas included: research with
the blind and vision impaired; benefit provision; consumer groups; disability; Maori and
Pacific; issues for the deafblind; employment; education; and the elderly.
The final sample of informants was selected by the researchers in consultation with the
RNZFB. Selection aimed to provide a broad mix of relevant expertise and representation
within the research.
Many of the key informants were blind or vision impaired themselves. Relevant findings
on the costs of blindness from these interviews have been incorporated into the research
findings where appropriate.
2.4.4 Focus Groups
Four focus groups were conducted with RNZFB members to further examine the day to
day costs of blindness.
Budget constraints limited the total number of groups possible. One group respectively
was conducted for: youth; persons of working age; elderly persons; and, parents of blind
and vision impaired children.
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Participant Selection
Specifications for the composition of each group were set to achieve a diversity of
representation based on: sex; ethnicity; age; type of vision impairment; employment status
(employed; self employed; unemployed); location; living situation. Partners, caregivers
and other support people were also invited to participate.
RNZFB staff members were asked to identify RNZFB members fitting the eligibility
requirements and composition targets set for each focus group. Purposeful recruitment
was then undertaken from the compiled lists of potential participants. Recruitment was
undertaken by telephone and conducted by members of the RNZFB 0800 team using a
pre-prepared recruitment script (refer to Appendices for recruitment script). Each
confirmed participant was sent a confirmation letter in the format of their choice,
confirming their participation and providing further details on the objectives of the research
and the focus group.
The final composition of each group is detailed in the Appendices.
Research Process
A total of thirty-eight people participated in the four focus groups (refer to Appendices for
further description of group participants). All groups were conducted at Awhina House,
Auckland and moderated by at least two members of the research team. Groups were
moderated using semi-structured interview schedules developed by the researchers in
consultation with the RNZFB (refer to Appendices for example of interview schedule).
Each group took between two and three hours.
2.4.5 Telephone Survey
A national telephone survey was undertaken of 200 RNZFB members using Computer
Assisted Telephone Interviewing (CATI). The survey gathered data on the financial, time
and to a lesser extent, opportunity and qualitative costs of blindness.
Questionnaire Design
The questionnaire was developed by the research team in consultation with RNZFB staff
(refer to Appendices for questionnaire). The development of the questionnaire was
informed by information derived from all previous stages of the research, in particular the
literature review and key informant interviews.
The questionnaire focused primarily on deriving information on quantitative financial and
time costs. While there was some exploration of opportunity and qualitative costs, it was
recognised that these costs are generally more appropriately explored through qualitative
methods.
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The questionnaire used in the survey was comprehensive and highly structured so as to
provide in-depth and detailed examination of costs experienced. Prior to and throughout
the interviews, respondents were reminded of the range and type of costs likely to exist
and reminded to focus only on those factors legitimately defined as costs. Interviewers
were trained to prompt and probe on answers as appropriate to further ensure compliance
to this requirement.
Respondent Selection
To ensure that the survey sample collected reasonable data from the range of members,
quotas were set by age, sex, ethnicity, location, eye condition. Quotas were also set to
ensure that a minimum number of employed and student members were surveyed.
Within these quota characteristics, respondents were randomly selected from the RNZFB
membership data-base.
Recruitment was carried out by telephone by staff of the Gravitas Research Survey Centre
in Auckland. A structured recruitment script was used to determine initial interest in
participating and to cover issues such as confidentiality (refer to Appendices for
recruitment script). Those interested in participating were sent a follow-up letter in the
format of their choice providing further information, including areas to be covered in the
interview. The letter assisted undecided respondents to decide about participation as well
as assisting confirmed participants to prepare for the interview.
Those receiving letters were re-called approximately one week later to either complete the
interview or to confirm participation and establish an appropriate time and day for the
interview to be completed.
Interview Coverage
The survey questionnaire covers the following potential cost areas:









Daily living including personal tasks and shopping
Equipment (including training)
Accommodation and Home Alterations
Education and Training
Employment
Transport / Travel
Medical and Health
Social, Recreational and Leisure
Unpaid and Voluntary Work
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Interviewing Process
The survey was fully piloted at the close of 2003 and a second round of piloting was
conducted in early 2004. Final interviews were conducted between 2nd March and 4th
April 2004.
The interview was comprehensive with each interview taking on average 54 minutes.
Respondents were offered the opportunity to break the interview at any stage and resume
at a later time - if they were feeling tired or needed time to consider questions. The
response rate (proportion of members contacted who completed the interview process)
was 67.3%.
In some instances, interviews were conducted involving both the respondent and a
support person (usually family members or caregivers). Where the RNZFB member gave
consent, some support persons were also solely responsible for responding to certain
sections (e.g. shopping). In fewer cases, surveys were totally completed by caregivers on
behalf of the RNZFB member. This ensured their participation in the survey, as they were
otherwise unable to participate independently (e.g. because of disability).
2.5 Survey Data Analysis
2.5.1 Data Weighting
The data collected was weighted by age, sex, location, ethnicity, acuity and whether
employed or not - using the RNZFB membership database as the target population.
2.5.2 Estimating Costs
Once the sample collected was weighted to be reflective of the structure of the RNZFB
membership, mean and total costs were calculated for each of the cost areas covered.
Mean costs were expressed as mean costs per member - acknowledging that not all
respondents and members incur every cost. The mean costs derived have been applied
to each of the three populations by creating mean cost figures by age, sex and acuity
(blind and visually impaired) and location and applying these to each population.
In order to put a financial value on time spent undertaking tasks and helping blind and
vision impaired people in addition to time that sighted people would spend on such
activities, we have valued time at $12 per hour. This is consistent with the monetary value
assigned to volunteer time in the “Value-Added for Voluntary Agencies” (VAVA) project
conducted by Price Waterhouse Coopers. In comparison, the Transfund Project
Evaluation Model valued time for non work travel purposes at $7/hr and time for work
travel purposes at $21.30/hr in July 1998. These values are used by Transfund to
estimate the financial cost of people being trapped in congested traffic. The value used
for the VAVA project falls between the upper and lower estimates provided by the
Transfund evaluation methods and because this project assesses both costs for
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employment and non-employment tasks the project team has decided to use the VAVA
project value of $12 p/hr for consistency purposes.
Three populations for blind and vision impaired people in NZ have been considered. The
first is the RNZFB membership. Since the RNZFB membership is a subset of all blind and
visually impaired people in New Zealand as membership is voluntary and eligibility criteria
based on sightedness apply, two further potential populations have been provided. These
estimate the total number of blind/vision impaired people according to ophthalmologists
and international literature and the second estimate is based on reporting in the Disability
Survey conducted by Statistics NZ in 2001.
2.5.3 Cost Calculations
Costs were recorded in the survey in a number of ways, based on the cost area under
discussion and respondent’s situation and recall. These include dollar costs, time spent in
hours and recording of equipment owned or held. Typical cost values were then applied
to equipment and time and these cost assumptions are detailed in the relevant sections
and in the appendices.
All costs were annualised and capital items were depreciated to provide a typical annual
cost.
2.5.4 Cost Allocation
The survey questioning established who met the costs identified and where these were
shared and to what extent.
Throughout the report, costs are categorised as being incurred by either the ‘individual’ or
‘society’. These are defined in preceding sections of the report.
2.6 Methodology Limitations
The limitations of the research methodologies used in the current research are discussed.
2.6.1 Survey Methodology
The limitations of using survey methodologies in cost of blindness research have been
previously discussed, particularly in relation to the reliance on participants to identify and
recall costs (Chou et al, 2003). Previous authors have also noted that some everyday
costs can be taken-for-granted (BCA, 2003, RNIB, 2000; Curtis & Blind Persons
Assembly, 1986). It has also been recognised that surveys may only provide an
assessment of current costs and do not account for ongoing costs and the “dynamics of
disability” (Curtis & Blind Persons Assembly, 1986). Surveys can also be particularly time
consuming for both participants and the interviewer (Newbold 1987).
Two studies have used personal dairy keeping in conjunction with other methods (BCA,
2003; Chou et al, 2003). Diary keeping is likely to provide a more accurate measure of
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costs, as once the cost is incurred it is immediately recorded, thereby eliminating reliance
on recall (Chou et al, 2003). The method does, however, require a considerable amount
of commitment on behalf of the participant and a significant resource investment.
Responses undertaken within the current study to address limitations of the survey
methodology have been discussed in preceding sections of the report.
2.6.2 Additive Effect of Other Disabilities
Given the age profile of blind and vision impaired persons, vision impairment is often
experienced with other disabilities. The multiple experience of disability may have an
additive effect on the costs of blindness experienced, for example, mobility being further
restricted by physical disability.
The current study has not attempted to factor in this potential additive effect and has
instead sought to concentrate singularly on those costs clearly attributable to blindness
and vision impairment. It is acknowledged that ‘extracting’ one cost from another is likely
to have been difficult for those respondents experiencing multiple disabilities.
2.6.3 Limited Evaluation of Indirect Service Related Costs
Key informant contributors to the research suggest that costs of blindness may indirectly
result from the level or type of service provision to blind and vision impaired people. For
example, some perceive mainstreaming education to have reduced the level of
specialised teaching support provided to blind and vision impaired students and the loss of
some skill development previously achieved through an institutional approach to
education. These outcomes are in turn suggested as creating further difficulties for young
blind people, for example, in the area of employment. While acknowledging that such
indirect costs may exist, it is beyond the scope of the current study to undertake the level
of evaluation required to examine such issues further.
2.6.4 Sampling Limitations
Any sample is constrained by its size. A sample of n=200 is not large and has a maximum
error of +/- 6.9% at the 95% confidence level (based on a random sample). Since the
survey sampled blind and vision impaired people rather than their families it is possible
that data collected on the impact on families is under recorded. However, the survey
process is detailed and robust and therefore provides comprehensive cost data on the
sample collected. In this sense the method can be considered to emphasise depth rather
than breadth in terms of the sample coverage. This was felt to be most appropriate for a
study of this kind, given limited resources.
Sample numbers of students and employed surveyed are small and data presented is unweighted. Consequently, results should be considered indicative only.
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2.6.5 Education Related Costs
At the time of submitting the final report, a range of data on the costs of providing
education services remains unavailable to the researchers (for further information please
refer to the separate document, ‘Data Collection Issues Encountered During the RNZFB
Costs of Blindness Research’).
2.6.6 Comparisons in Time Spent Undertaking Activities
The research provides some discussion of potential differences in the average time blind
and vision impaired individuals spend undertaking certain activities and the average time
spent by the general New Zealand population. This discussion is drawn from a
comparison of the Costs of Blindness survey findings on time spent undertaking activities
and comparable data from the 1998/1999 Statistics NZ Time Use Survey. Data is
compared for activities where the questions used in the survey are comparable to those
used in the 1998/1999 Time Use Survey.
The comparisons provide some means to estimate whether blind and vision impaired
individuals spend more or less time on certain activities compared to the general
population. The findings should, however, be treated as indicative only as there are a
number of methodological limitations preventing definitive quantitative comparison. In
particular, the 1998/1999 Time Use survey data was collected using personal activity
diaries while the Costs of Blindness survey data is derived from respondent self-recall and
estimates. The diary methodology will provide more reliable data as respondents are
asked to record actual time spent undertaking activities over a defined period of time, with
records likely made immediately on completion of a task. In comparison, the recall
method relies on respondents making assessments of time spent during the interview
process itself. We believe this is likely to result in an under estimation of the time spent
undertaking activities.
The sample size for the Costs of Blindness survey is also small, providing a further
limitation on the reliability of comparisons.
In addition, care is needed when interpreting the meaning of any differences identified
between blind and vision impaired individuals and the general population. For example,
less time spent on an activity by blind or vision impaired individuals may indicate more
time spent by others undertaking or supporting completion of the activity concerned.
Due to the limitations of drawing time spent comparisons from the available data, the
findings are only described qualitatively and no quantitative data on differences are
presented.
2.7 Report Structure
The review of the research literature is initially presented followed by a discussion and
cost estimates of welfare provision to blind and vision impaired people within New
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Zealand. The current and future number of blind and vision impaired people living in New
Zealand is then estimated. Subsequent sections then examine the costs of blindness
related to education, employment, daily living, and transport and mobility. The social
costs of blindness are also discussed. Findings are then discussed and final conclusions
drawn, including research implications and future research needs.
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3.
LITERATURE REVIEW
3.1 Introduction
Previous research has traditionally been undertaken to understand the costs of blindness
to wider society (Chou et al, 2003, Wright et al, 2000). In doing so, studies have often
sought to provide evidence of the cost effectiveness of enhancing blindness prevention
strategies. While this focus is understandable, there is increasing awareness of the need
to also investigate the costs of blindness as experienced by persons whose situation is
beyond prevention (BCA, 2003; Chou et al, 2003, RNIB, 2000; Newbold, 1987; WHO,
1997). There is also increasing recognition that costs of blindness research must
understand the life time costs of blindness, including time, opportunity and social costs, as
well as financial costs and the costs of service provision.
3.2 Defining “Costs of Blindness”
The ‘costs of blindness’ are defined in various ways within the literature (Chou et al 2003,
Wright et al, 2000, Newbold, 1987; Curtis et al, 1986). Definitions are both specific and
broad in terms of defining what constitutes a cost. A number of different costs have also
been defined; for example, direct, in-direct, optional, non-optional, extra, and total costs.
Some consistency in definition terminology and approach is apparent. Regardless of
exact definition, previous studies commonly make a distinction between those costs
incurred by the individual and those incurred by wider society. A number of studies use
the term ‘direct’ costs when referring to the ‘societal’ costs of blindness, while ‘indirect’
costs is commonly used to refer to ‘individual’ costs (Chou et al, 2003, WHO, 2003; Wright
et al, 2000).
The World Health Organisation (WHO) (2003) sees the ‘direct’ costs of blindness being
measurable though government and organisational expenditure. WHO calculates the
global, direct costs of blindness to be US $25 billion per annum. They estimate this figure
to at least double, if ‘indirect’ or individual costs are also accounted for.
Chou et al (2003) also define the costs of blindness as ‘direct’ and ‘indirect’. ‘Direct’ costs
are defined as “resources consumed by health care interventions or programmes, which
aim to prevent and treat eye disease and provide rehabilitation and government
supports…” (2003: 336). ‘Indirect costs’ are seen to include ‘out-of-pocket’ expenses, the
value of production lost to society, costs to the individual, and cost to his or her family and
friends due to vision impairment” (2003: 337).
Newbold (1987) also conceives the costs of blindness to fall into two categories; costs
faced by the affected individual, their family and carers and, costs to society.
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In a recent study, the Blind Citizen’s Association (BCA) of Australia investigate the ‘direct’,
‘indirect’ and ‘opportunity’ costs of blindness (2003). The BCA refers to the ‘non-optional
costs’ of blindness. While this term is not defined further, it is similar to the notion of ‘extra
costs’ (Curtis & Disabled Persons Assembly, 1986). In the Curtis study, ‘extra costs’ are
defined as those “…above and beyond the costs that would be encountered if the person
did not have a disability” (1986:02). Similarly, a 2000 study by the Royal National Institute
of the Blind is also concerned with ‘extra costs’, particularly those related to everyday
living (RNIB, 2000).
The World Health Organisation (WHO) moves beyond the more simplistic distinction of
‘direct’ and ‘indirect’ costs of blindness to identify multiple costs of blindness – ‘personal’,
‘social’ and ‘economic’ (WHO, 1997). The costs of blindness are seen as extending from
the individual and his or her family, to the wider community and then, globally. The WHO
report also advocates that the economic and social costs of blindness be considered from
the perspectives of both the blind or vision impaired individual as well as the country as a
whole (WHO, 1997). This position recognises the range of variables that can influence
and shape interpretations of the costs of blindness, for example, an individual’s personal
perception of their situation and their culture. In essence, the costs of blindness are seen
as specific to the person, his or her society and their cultural context.
3.3 Previous Costs of Blindness Studies
Newbold (1987) undertook a seminal study on the costs of blindness in New Zealand in
the late 1980’s. Commissioned by the RNZFB, the research provides a largely qualitative
examination of the costs of blindness from the perspective of blind and vision impaired
individuals. The study examines direct costs (such as equipment costs), indirect costs
(such as travel costs), lost earnings and the experience of other household members and
carers (Newbold, 1987).
In the first study of its kind in the United Kingdom, the Royal National Institute for the Blind
(UK) (RNIB) undertook costs of blindness research in 2000 (RNIB, 2000). The research
identifies ‘extra costs’ incurred by blind or vision impaired persons in five key areas:
Household Tasks; Assistance; Communication; Shopping; and Transport. The study
recognises the need to understand costs according to life stage and consequently study
participants are segmented by parents of vision impaired children, vision impaired
students, those seeking employment, parents, working age and the older aged.
Like Newbold (1987), the RNIB study does not attempt to quantify the extra costs of
blindness, however, the study concludes that existing benefits provided to vision impaired
individuals in the United Kingdom only cover a small proportion of their needs (RNIB,
2000).
The Blind Citizens of Australia (BCA) have also recently undertaken research into the
costs of blindness (BCA, 2003). The study investigates costs by age, employment status,
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gender, ethnicity and geographic location. Consistent with the work of WHO (1997), key
findings include that non-optional costs of blindness are highly personal, that gender and
culture are significant factors in how individuals perceived non-optional costs and, that
costs are compounded by the experience of other disabilities and old age.
The BCA study also shows a relationship between income and community participation.
Vision impaired individuals with higher incomes are shown to have higher non-optional
costs due to increased community involvement, while those with fewer means are often
unable to participate in such activities as they struggle to meet even basic needs.
A further cost of blindness study is currently being undertaken in Australia (Chou et al,
2003). The research will collect costs of blindness data using two questionnaires as well
as cost diaries which will be completed by participants in monthly batches over one year.
Identified cost categories include those relating to medicine, health and community
services, informal care and support and other expenses. A preliminary study piloting the
diary method concludes the average, extra monthly cost of blindness to be AUS$316.72
(Chou et al, 2003).
3.4 Individual Costs of Blindness
3.4.1 Communication
Blindness or vision impairment severely reduces the amount of information that people are
able to receive and impacts on the way information is able to be processed (Ryan, 2002).
A number of studies have examined the additional costs associated with this impairment.
These include the inaccessibility of principle sources of information such as newspapers,
magazines and books (Newbold, 1987), the need for special communication equipment
and technology (La Grow & Good, 2003, RNIB, 2000; Hanley 1992) and the need for
additional support in undertaking communication activities (Newbold, 1987).
The RNIB (2000) discusses costs associated with higher than average telephone use,
costs associated with alternative communication methods (e.g. tape recorded letters) as
well as the opportunity costs associated with being unable to access a variety of
information.
Newbold (1987) discusses the communication difficulties often encountered by blind and
vision impaired people in social situations. The inability to attract and maintain eye
contact makes it particularly difficult to initiate and conduct conversations. The inability to
receive visual feedback and to detect responses such as sincerity, humour or irony, can
also make it hard to respond appropriately within interactions with others. Newbold (1987)
notes that the blind or vision impaired can easily become passive in social situations,
relying on others to initiate contact. Communication can be stressful and frustrating
leading blind and vision impaired people to withdraw from public situation or tending to
only associate with close friends (Newbold, 1987).
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3.4.2 Daily Living
Identified additional costs related to daily living include: the cost of specialised household
equipment and/or the need to modify existing equipment (RNIB, 2000); the additional time
taken to undertake daily activities (Newbold, 1987); and, the need for either paid or unpaid
assistance to undertake household and other daily living activities (Newbold, 1987;
Guralnik, 1999; RNIB, 2000). The RNIB (2000) also note increased costs associated with
‘over-cleaning’, both in terms of the time taken as well as excessive use of cleaning
products and equipment.
The RNIB (2000) study reports that the elderly often live alone and therefore may be more
dependent on home modifications and outside hired help to maintain their independence.
The authors note that the situation of the elderly blind and vision impaired may be further
complicated by other disabilities, illness and general body decline.
Results from the 2001 New Zealand Disability Survey show that 71% of adults in
households with sight limitations used some kind of special equipment or service for
people who are blind or vision impaired (Statistics NZ, 2003). Equipment used includes
glasses and contact lenses (39,900 people) and hand held or desk-mounted magnifiers
(18,200 people). The survey also concludes that 97% of adults in residential facilities with
sight limitations use special equipment or services. This included glasses or contact
lenses (5,500) and large print reading materials (1,900 people).
3.4.3 Accommodation
A number of studies conclude that blind and vision impaired people face significant
additional costs related to their accommodation (BCA, 2000, Newbold, 1987). Identified
costs include: the need for special house design or layout; the need to consider (and pay
for) housing location in relation to access to amenities, public transport and proximity to
work; the difficulty of finding suitable accommodation; and additional safety and security
concerns.
3.4.4 Shopping
Identified costs of blindness associated with shopping include: greater reliance on others
to undertake shopping (Newbold, 1987); additional time taken to complete shopping
activities (Newbold, 1987); and lost savings due to the difficulty of shopping at larger
discount stores as well as the difficulty of fully capitalising on sales or specials (RNIB,
2000).
3.4.5 Transport/ Mobility
Transport and mobility has been identified as a significant additional cost area for blind
and vision impaired persons (Newbold, 1987, Curtis et al, 1986). Access to affordable
transport has been inextricably linked to the blind or vision impaired persons’ ability to be
active within the community (BCA, 2000). Issues related to transport and mobility
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generally have also been identified as being vital to success in other areas of the blind or
vision impaired person’s life (Hanley, 1992).
In their general study of disabilities, Curtis et al (1986) identify transport as the most
significant area of cost to individuals with a disability. The authors conclude that the cost
of transport can severely restrict the disabled person’s ability to participate in activities
outside the home and estimate that transport costs account for half of the overall extra
cost faced by those with a disability.
Other transport related costs identified include: the expense associated with high taxis use
(Newbold, 1987); high reliance on public transport and the subsequent difficulties and time
costs associated with using such transport (RNIB, 2000, Newbold, 1987) and the reliance
on others when travelling by private car (Newbold, 1987).
The costs associated with having a Guide Dog have also been previously discussed
(Newbold, 1987). Training costs are significant, with training and acquisition a lengthy
process. The RNZFB estimates it costs $22,000 per year of training, a significant cost to
the Foundation and programme sponsors (RNZFB Website). Costs to the individual can
include the cost of food, vet bills and the requirement for a fenced property with a
reasonable sized section. Newbold (1987) suggests that having a Guide Dog may restrict
mobility due to some premises and taxis not allowing guide dogs on premises.
3.4.6 Parenting
Additional costs faced by the parents of vision impaired children have been identified to
include medical expenses, the need for home modifications (e.g. safe playing areas), and
the loss of work, employment opportunities and income as a result of the level of care
needed by vision impaired children (RNIB, 2000).
3.4.7 Social Costs
It has been noted that blind and vision impaired people are at risk of becoming socially
isolated. The extent of their social world may become restricted due to the difficulty of
learning new faces or recognising old acquaintances (Whitbourne, 1985). Increasing
social isolation can result in a loss of varied, stimulating and fulfilling social roles, support
and contact (Mott & Riggs, 1992). Older people may lose confidence in social situations,
increasing their risk of becoming housebound and in developing feelings of insecurity,
loneliness and worthlessness (Advisory Council for the Community Welfare of Disabled
Persons, 1989).
A range of psychological impacts from blindness and vision impairment have also been
described. These include grief, depression and disorganisation of one’s personality
(Scott, 1991), resentment, fear, uncertainty, denial and anxiety (Sacks, 1996; Hudson,
1994).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 21
Higgins and Ballard (1999) investigate the meaning of blindness in the lives of four blind
people through open-ended interviews. The authors stress the need to consider disability
as a social issue in that disability occurs in the manner dictated by society. They believe
that disability should not be solely defined by the medical model but must also account for
the disadvantage or restriction of activity which occurs when a society takes no or little
account of people with impairments and exclude them from mainstream social activities.
The authors challenge the notion of the ‘personal tragedy of disability’, believing that
disability is not randomly distributed, but rather caused by social and cultural standards of
living. They discuss the stereotypes and stigmas attached to being blind with typical
stereotypes seen as presenting blind and vision impaired persons as helpless, docile,
dependent, melancholic, aesthetic (more sensitive to music and literature) and serious
minded.
Six themes emerge from the research on the lived experience and meaning of being blind.
These are the idea of being blind as: different; expensive; requiring special instruction;
having limited life (in terms of opportunities); possessing a bond with other blind and pride
in identity; and being excluded from the opportunity to teach others.
3.4.8 Costs to Partners, Family, Friends and Carers
Fewer studies were identified which focus on the costs of blindness experienced by
partners, families, friends and carers of blind and vision impaired persons. However,
some studies have recognised the substantial financial, time and opportunity costs that
are incurred when undertaking care and support roles (Chou et al, 2003, Newbold, 1987,
Curtis et al, 1986).
In an American study, Meyers, Lukemeyer, & Smeeding (1998) observe that children with
disabilities or chronic illness require extra care that may be expensive not only in terms of
dollars, but also in terms of time and forgone opportunity. This includes additional time
spent by family and others in care giving and subsequent lost employment and income
opportunities.
Meyers, Lukemeyer, & Smeeding (1998) define ’subjective private costs’ to be significant
costs of disability. This term is defined as qualitative emotional, psychological and
interpersonal costs not usually accounted for in traditional cost measures which tend to
focus on the costs of medical care, rehabilitation services, special equipment and indirect
costs such as the caregiver’s lost productivity. The authors also see the need to capture
additional monetary costs associated with transportation to doctors and specialists, home
and vehicle modifications, extra costs of more specialized childcare, special food and
even clothing.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 22
Half of the families in the Meyers, Lukemeyer, & Smeeding (1998) study were shown to
incur direct, out-of-pocket expenses for special medical expenses, food, transportation, or
other goods and services directly related to their child’s special needs. The authors
conclude that the indirect costs of caring for disabled children are as substantial as those
direct costs.
A limited number of other studies have reported similar costs incurred by those
responsible for supporting and caring for blind and vision impaired people. Chou et al
(2003) note that family members may have to give up, or reduce their employment in
order to provide assistance. Blindness or vision impairment can also result in a change in
the family breadwinner and increased likelihood that partners and others will be required
to take on a larger proportion of activities associated with the home and everyday living
(Newbold 1987).
3.5 Societal Costs of Blindness
A number of research projects have investigated to varying levels of detail the costs of
blindness to wider society. Most studies have focussed on government and organisation
costs related to benefits, medical subsidies and lost productivity.
The World Health Organisation (2003) calculates the global government and
organisational costs of blindness to total some US$25 billion annually. The University of
Melbourne’s Centre for Eye Research Australia (CERA, 2004) estimates the governmental
cost of Blind pensions and entitlements to be AUS$625 million annually. An earlier
American study identified an annual cost of blindness to society of US$4 billion to the
American government (Chiang, Bassi & Javitt, 1992).
Two more recent studies have attempted to quantify the government and wider societal
costs of blindness. Wright, Keeffe & Thies (2000) assess the costs of blindness to the
Australian government and community through examining the cost of providing
government pensions, subsides, concessions, equipment and services. The study
undertook a case study approach and calculated costs for three scenarios of vision
impairment: a retired person with age-related macular degeneration (Case One); a
working age person with diabetic retinopathy (Case Two); and, a school student with
congenital vision impairment (Case Three). Annual direct costs were concluded at
AUS$14,686 ($9,749 - $22,507) for Case One; AUS$17,701 ($9,669 -$26,720) for Case
Two; and AUS$15,948 ($5,106 - $23,798) for Case Three.
A recent UK study (Ethical Strategies Ltd, 2003) also examines government and societal
costs of blindness. Cost areas examined include: healthcare - including hospitalisation,
surgery, diagnostic procedures, medications, physician visits and nursing time; costs to
patients and families including prescriptions, home adaptations, visual aids; time costs
including time spent by relatives and household members caring and assisting blind or
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 23
vision impaired persons; and other costs including social services and benefits provided,
as well as lost productivity.
Using a case study approach, the researchers generate cost estimates for five scenarios
of vision impairment1. This requires the modelling of typical patterns for the onset and
progression of conditions, treatment schedules and subsequent requirements for
rehabilitation and support services. A series of assumptions are also developed for each
case regarding the use of resources, treatment received and the cost of providing
respective treatment and services. To test the assumptions made, sensitivity analyses
are applied either by suppressing or removing some of the assumptions included in the
overall assessment.
Estimated lifetime costs are provided for each case study. These range from £19,120 for
Case Three through to £257,184 for Case Five. Reflecting age of onset, 48% of the costs
for the 50 year old male represented productivity forgone while 61% of costs for the 16
year old female were attributed to productivity loss. Almost all the costs (96%) estimated
for 70 year old female in long-term residential care was attributed to the costs of the
residential care provided.
Prevalence estimates were identified for three categories - children, working age and the
elderly. Results indicated that the cost of 306,480 cases (based on the official Blind
register) of blind and partially sighted persons in the UK cost between £1.4 and £2.9 billion
in 2002. The authors recognise that the blind register underestimates the prevalence of
cases and also generates a further cost of £4.1 to £8.8 billion for a projected total of
919,440 cases.
1.
A 50 year old male suffering from severe vision loss as a result of proliferative retinopathy (£237,591)
2.
A 70 year old female with AMD in long-term residential care (£196,876)
3.
A 65 year old male with cataracts in both eyes living in a local authority sheltered accommodation (£19,120)
4.
A 60 year old female with glaucoma who lives with her husband at home (who provides most of her care
services) (£40,324)
5.
A 16 year old female student with severe vision loss as a result of retinitis pigmentosa who lives with her
parents (£257,184)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 24
4.
WELFARE BENEFITS AND THE VISION IMPAIRED
This section discusses the welfare benefits available to blind and vision impaired people in
New Zealand. The section begins with an historical overview of blind welfare and
summarises the rationale and objectives underlying welfare provision. The welfare
benefits currently available to blind and vision impaired persons are identified and the
annual costs of providing these estimated.
4.1 Welfare for the Blind - Historical Overview
In 1924, an amendment to the Pensions Act (1896) meant that the blind were the first
disability group to become eligible to receive a pension (McKenzie, 2002). The legislation
provided for a flat rate benefit that was not means tested to an upper limit of £143 per
annum for total income from all sources. A financial incentive known as the blind subsidy
was also offered to encourage the blind to find paid employment therefore enabling them
to play a more active role in the community. The incentive comprised the offer of an
additional bonus of 25 percent of any wages earned, provided that the annual
accumulated income from all sources did not exceed £182 (McKenzie, 2002).
The 1924 amendment also provided the foundation for more profound changes that would
come later in the form of the Social Security Act (1938). This legislation provided for
disability, unemployment, and sickness benefits. A basic annual benefit of £78 was
available to an unmarried invalid. The 25 percent earning subsidy remained, meaning that
the blind were able to earn up to £143 a year without impact on their pension. In 1943,
the special earning provision was increased to £156, with the exception remaining
unchanged until 1957 (McKenzie, 2002).
In considering the rationale for the blind subsidy during this time, the Ministry of Social
Development reports the subsidy to be in line with the societal conditions of the time
‘when there was considerable sympathy to the plight of blind people. In addition, the
technology and aids available for people with disabilities at the time were basic and
therefore employment opportunities were severely restricted.’ (Ministry of Social
Development, Personal Communication, 26th February, 2004).
Means testing of blind benefits was abolished in 1954 by the Commonwealth Government
of Australia and also removed in Sweden and Denmark. The rationale for this move was
that the blind experience additional costs to sighted people and that these costs remain
irrespective of employment status (McKenzie, 2002). As a result of the overseas
experience, efforts were stepped up in New Zealand for a similar abolishment of means
testing. In 1957, the New Zealand government increased the upper earnings limit from
£156 to £520, meaning that the blind were free to pursue normal careers without negative
financial consequences. At the same time, however, the government rejected a petition to
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 25
totally abolish the means test, stating that its removal for one disability group only was not
justified.
Under a new government, however, the means test was eventually removed under the
Social Security Amendment Act (1958). As a result there was an immediate increase in
the number of blind workers, both in industry and the public service. However, an
anomaly not addressed by the 1958 legislation was the ‘intimacy tax’ that discriminates
against blind partners of sighted spouses who are employed (McKenzie, 2002). Through
this provision, the earnings of the spouse are taken into account in the assessment of the
benefit, a consideration still in effect today.
Between the late 1950s and early 1970s a variety of subsidies and discounts were offered
to the blind including air travel, steamship travel, postage, rail travel, sighted guides, and
bus travel. However, there was still tension between advocates seeking special
consideration to be granted to the blind, and the government’s desire to treat all those with
disabilities the same.
The Accident Compensation Act (1972) enabled those blinded in an accident to claim
ongoing blindness-related expenses, as well as a lump sum. Only around 10% of blind
persons were blinded as a result of an accident, and so in order to establish some
measure of fairness, the Disabled Persons Community Welfare Act (1975) was
introduced. Under this legislation, those with disabilities could access assistance with
employment-related expenses, loans for essential home alterations and motor vehicles,
and childcare, among other things.
In 1981, the Department of Social Welfare set up a Rehabilitation Committee. This
organisation focused on promoting a greater political voice for the sight impaired rather
than recommending greater financial assistance from the government.
In 1985, the Labour Government announced extra funding for the support of the severely
disabled. A number of individual benefits were increased and the six month stand-down
period before the disability allowance could be received was removed. However, in the
following year, all benefits became subject to taxation, largely negating any gains. Some
blind recipients of government assistance who were also working were then pushed into
higher tax brackets that now assessed total income, making them worse off than before
the benefit review.
With a new National government in 1990 came benefit cuts. As part of this reform, the
government divided the disabled support industry into ‘purchasers’ (who bought services
and were funded directly by the government) and ‘providers’ of actual services.
The Human Rights Act (1993) become an important piece of civil rights legislation for the
blind in making it illegal to discriminate against anyone because of their disability in the
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 26
areas of ‘government or public sector activities, employment, access to education, access
to public places, vehicles, and facilities, provision of goods and services, provision of land,
housing, and accommodation, industrial and professional associations, qualifying bodies
and vocational training bodies and partnerships’ (ABC, 2003).
Further sources of civil rights protection for blind and vision impaired persons in New
Zealand are the New Zealand Disability Strategy and the New Zealand Bill of Rights Act
1990. A central goal of the Disability Strategy is to remove barriers that impinge on the
human rights of those with disabilities and to create an environment in which disabled
people can thrive.
Through the goal of ensuring that the needs and rights of the disabled are considered in
government decision-making, inclusiveness is a key element of the New Zealand
Disability Strategy. In addition to directing each government department to consider
disabled people in their decision-making, departments are also required to have an
implementation plan outlining how they are contributing to the aims of overall strategy.
Local territorial authorities and other government bodies are also expected to contribute to
the overall goals of the strategy.
4.2 Current Benefits Available
The main government and quasi government providers of support and assistance to the
blind and vision impaired are Work and Income New Zealand (WINZ) and the Accident
Compensation Corporation (ACC).
4.2.1 Work and Income New Zealand (WINZ)
Work and Income New Zealand (WINZ) administrate a range of benefits to the
unemployed, those retired and those permanently or temporarily unable to work because
of disability or illness (see Appendices for a full description of benefits available). Blind
and vision impaired persons are eligible for all standard benefits and may also be eligible
for the Blind Subsidy, an additional benefit payable with the Invalids Benefit (see later
discussion).
Provision of benefits is dictated by three key Acts of Parliament: the Social Security Act
1964; the Social Welfare (Transitional Provisions) Act 1990 and the New Zealand
Superannuation Act 2001.
The benefits available have a range of objectives including: to support job seekers until
they find paid employment; to support those permanently or temporarily unable to work
because of disability or illness; to recompense for regular costs incurred because of
disability; to recompense for medical costs for those on low incomes and/or with high, ongoing medical costs; to provide childcare support and subsidies; to support for
accommodation costs; and to provide family support.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 27
4.2.2 Accident Compensation Corporation
Accident Compensation Corporation (ACC) provides a range of compensation and
support to those suffering personal injury. ACC aims to prevent injury and provide
treatment, care and rehabilitation if injury does occur. A primary goal is to assist people
back to work or independence at a price that offers high value to levy payers and all New
Zealanders
ACC operates under the Injury Prevention, Rehabilitation and Compensation Act 2001
which reprioritises the corporation’s activities in line with the Government’s key goals of
injury prevention, complete and timely rehabilitation, fair compensation and the
observation of claimant’s rights.
General assistance to which those blinded or vision impaired through accident may be
eligible includes weekly financial compensation (calculated from pre-injury earnings), lump
sum compensation, the Independence Allowance and rehabilitation assistance (e.g.
provision of special equipment or aids, home help and transport subsidises) (see
Appendices for detail).
People who have become blind or vision impaired as a result of a personal injury covered
by ACC are also able to access a range of specific services if they meet certain criteria
with medical certification. Training and coaching services primarily seek to support
claimants back to independence and include services in daily living, orientation and
mobility, literacy and communication.
A transcription service (accessible format
production), an ‘equipment for independence’ service and Counselling Service are also
provided (see Appendices for detail).
4.3 Provision and Economic Cost of Benefits Provided
The number of blind and vision impaired people receiving government benefits is
presented below where this data is available. The total and mean (per person) annual
costs of providing these benefits are estimated.
4.3.1 Invalids Benefit
Since 1998 there has been a steady increase in the number of people receiving the
Invalid’s Benefit whose primary incapacity is identified as blindness or vision impairment
(refer to Table 1).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 28
Table 1: Total Number of Recipients
Invalids Benefit (Blind or Vision Impaired)
Year
Total number
1998
1,171
1999
1,205
2000
1,265
2001
1,307
2002
1,322
Approximately 60% of recipients of the Invalids Benefit (Blindness or Vision Impairment)
are male, a trend evident in the data from 1998 through to 2002.
The majority of recipients are aged between 20 and 64 years. In 2002, recipients aged 40
to 64 years made up 51% of all recipients. Since 1998, recipients 60-64 years of age
have increased the most in number. Recipient numbers in the 55-59 year age cohort
have also steadily increased.
Receipt of the Invalids Benefit (Blindness or Vision Impairment) have remained
consistently low for those aged 16 and 17 years and 65 years and older. Those over 65
years make up 1% of all recipients in any year since 1998. Rates for recipients aged 1819 years have also remained low since 1998.
A regional comparison of Invalids Benefit uptake shows Manukau as having significantly
and consistently higher rates of blind or vision impaired persons in receipt of this benefit.
The Waitemata (Auckland), Canterbury and Wellington regions show the next highest
rates of uptake. Nelson, Northland, East Coast and Taranaki show the lowest levels of
blind or vision impaired persons receiving the Invalids Benefit. As with the whole of New
Zealand, most regions show an increase in persons receiving the Invalids Benefit for the
reason of blindness or vision impairment, but the regions of Manukau, Canterbury and
Wellington show some decline in recent years.
Based on a weekly snapshot of Invalids Benefit receipt for reason of blindness or vision
impairment at 27 June 2003, 2,392 people received a total of $553,000. This implies an
annual cost of $28.8m.
Invalids Benefit recipients may specify up to four incapacities but with one being identified
as the primary reason for receipt of the benefit. The following table displays the number of
people as at 27 June 2003 by incapacity and the total amount received:
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 29
Table 2: Invalids Benefit recipients for reason of blindness or vision impairment by
incapacity, total numbers, and amount received and mean amount received
Incapacity
Number of People
Total amount
received
Mean amount
received
Blind Primary
799
$9.6m
$12,047
Other Primary+ Blind
941
$11.2m
$11,945
Blind TOTAL
1740
$20.9m
$11,992
Vision Impairment
Primary
518
$6.3m
$12,202
Other Primary+ Vision
Impairment
134
$1.6m
$11,820.60
Vision Impairment
TOTAL
652
$7.9m
$12,123
TOTAL
2392
$28.8m
$12,028
As shown in Table 2 the persons citing blindness as either their primary or other
incapacity make up the majority of persons on the Invalids Benefit for reason of blindness
or vision impairment and receive 72.5% of the total funds. However, those receiving the
Invalids Benefit for reason of vision impairment, either as primary or other incapacity, on
average receive a greater payment with an overall annual mean payment of $12,123.
4.3.2 The Blind Subsidy
As at February 2004, the Ministry of Social Development (MSD) reports only one person
receiving the Blind subsidy at a rate of $6.14 per week. MSD notes that ‘the situation
regarding employment for blind people has changed over the past 40 years. Technology
now means that it is easier for many blind people to participate in mainstream
employment. The need for a provision like the blind subsidy has declined and take up of
the subsidy has been at minimal levels for the past few years’ (Ministry of Social
Development, Personal Communication, 26th February 2004).
4.3.3 Sickness Benefit
Since 1998, the number of recipients of the Sickness Benefit with blindness or vision
impairment as the primary incapacity has remained fairly stable (refer to Table 3).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 30
Table 3: Total Number of Recipients
Sickness Benefit
Year
Total number
1998
191
1999
172
2000
173
2001
169
2002
180
As with the Invalids Benefit, receipt of the Sickness Benefit (blindness or vision
impairment) is skewed towards males. Over the last 5 years, males comprise on average
71% of all recipients of this benefit.
On average, 88% of recipients of the benefit are aged between 20 and 64 years. Over the
last five years, recipients in the 50 to 60 year age cohort have showed the highest rates of
receipt when compared to any other age group. Reflecting this, persons aged between 40
and 64 years made up 63% of all recipients in 2003. In comparison, those over 65 years
make up on average 3 percent of recipients, while in the last five years, only two persons
17 years or younger have received the benefit.
As with the Invalids Benefit, highest levels of receipt occur in Manukau, then Waitemata
(Auckland), Waikato and Wellington. Lower levels occur in Taranaki, Southern, Nelson
and Central regions.
As at 27 June 2003 there were 329 people receiving the Sickness Benefit for reason of
blindness or vision impairment, the total annual amount received is calculated to be
$3.2m. The table below shows a breakdown of this number and funds by incapacity:
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 31
Table 4: Sickness Benefit recipients for reason of blindness or vision impairment by
incapacity, total numbers, and amount received and mean amount received
Incapacity
Number of People
Total
received
Blind Primary
8
$73,700
$9,216
Other
Blind
117
$1.1m
$9,775
Blind TOTAL
125
$1.2m
$9,739
Vision Impairment
Primary
194
$1.9m
$9,626
Other
Primary+
Vision Impairment
10
$94,000
$9,421
Vision Impairment
TOTAL
204
$2.0m
$9,616
TOTAL
329
$3.2m
$9,663
Primary+
amount
Mean
received
amount
In contrast to the Invalids Benefit, the majority of persons receiving the Sickness Benefit
cite vision impairment as their primary incapacity. However, those citing blindness as a
secondary incapacity have the highest annual mean payment of $9,739.
4.3.4 Sickness Benefit (Hardship)
Relatively few blind and vision impaired persons have received the Sickness Benefit
(Hardship) since 1998 and the total number of recipients has been in decline since this
time (refer to Table 5)
Table 5: Total Number of Recipients
Sickness Benefit (Hardship)
Year
Total number
1998
24
1999
19
2000
18
2001
13
2002
14
While males (2002= 62%) again comprise a large portion of recipients, prior to 2000,
receipt of the benefit was fairly equally distributed across the sexes.
In 2002, 94% of recipients were aged between 20 and 64 years. In 1998, those aged 65
years or older made up 21% of recipients, however, numbers in this group have steadily
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 32
declined to 6% in 2002. In the last five years, only two people under the age of 24 years
have received this benefit for reason of blindness or vision impairment.
Over the last five years, Manukau is the only region to show fairly stable numbers of
recipients. In 2002, recipients from the region comprised 79% of all those receiving this
benefit. Since 2000, all other regions have respectively contributed less than 5% of
persons receiving the benefit.
Total annual costs for Sickness Benefit (Hardship) are included in the Sickness Benefit
calculations see Table 4.
4.3.5 Disability Allowance
As at 27 June 2003 of those receiving the Invalids Benefit or Sickness Benefit for reason
of blindness or vision impairment 64% received a Disability Allowance. The annual
amount received is calculated to be $2.0m. The table below provides a more detailed
breakdown of Disability Allowance receipt:
Table 6: Disability Allowance recipients for reason of blindness or vision impairment by
incapacity, total numbers, and amount received and mean amount received
Incapacity
Number of People
Total
received
Blind Primary
495
$689,000
$1,393
Other
Blind
741
$795,000
$1,073
Blind TOTAL
1236
$1.5m
$1,201
Vision Impairment
Primary
405
$398,000
$984
Other
Primary+
Vision Impairment
97
$118,000
$1,218
Vision Impairment
TOTAL
502
$517,000
$1,029
TOTAL
1738
$2.0m
$1,151
Primary+
amount
Mean
received
amount
As shown in the table above the majority of persons receiving a Disability Allowance as at
27 June 2003 cited blindness as a secondary incapacity. Those citing blindness as
primary incapacity have the highest mean annual payment at $1,393.
4.3.6 ACC Weekly Compensation
Accident Compensation Corporation (ACC) covers individuals for personal injury
treatment resulting from an accident. Table 7 shows the number of claimants and value of
claims for the 2002/03 financial year by assistance provided to people for injuries to the
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 33
eye. Information on recipients who are permanently affected by blindness or vision
impairment as a result of their accident cannot be extracted from those persons whose
eye injury is only temporary or did not have implications for their sight. As such, the value
of this information in understanding cost experienced as a result of blindness or vision
impairment occurring through accident is limited.
There were 2,500 new cases and 2,200 existing cases receiving financial assistance
relating to eye injuries. It should be noted that the number of cases is not equivalent to
the number of people in receipt of compensation. It is likely that one individual would be in
receipt of more than one compensation type, and would therefore be represented more
than once as shown in Table 7. ACC provided $10.4m financial assistance to claimants
for eye related injuries.
In the past five years the value of financial assistance has grown by 171% ($6.6m) from
$3.8m in 1998/99, and the number of cases has increased by 93% (2,200).
Table 7: Total Number of Cases and Financial Value
ACC Claims- Eye Injuries (2002/03)
Claim
New
Ongoing
Cases
Value
Cases
Value
Miscellaneous
12
$
29
$
Weekly Compensation
522
$ 1.5m
193
$ 3.4m
Independence Allowance / Lump
Sums
16
$
59,800
186
$
577,000
Survivors' Grants
8
$
90,000
14
$
98,000
Death Benefits
9
$
77,300
2
$
25,200
Vocational Rehabilitation
23
$
13,200
66
$
102,600
Support for Independence for Non
Serious Injury
309
$ 1.0m
249
$
954,500
Support for Independence
Serious Injury
67
$
106,600
91
$
414,700
Medical Treatment (Med Fees)
775
$
241,500
849
$
317,600
Medical Treatment (Entitlement)
21
$
10,900
17
$
20,600
Hospital Treatment
159
$
465,000
89
$
284,100
Assessments
185
$
100,500
211
$
176,000
Dental Treatment
27
$
23
$
10,000
Transport to Treatment
328
$
160
$
84,700
TOTAL
2,461
$ 3.9m
2,179
$ 6.5m
for
6,700
10,000
249,200
22,200
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 34
4.3.7 Other Benefits
Other benefits that blind or vision impaired persons may receive include most prominently
the Unemployment Benefit and NZ Superannuation. It would also be possible for blind
and vision impaired persons to be receiving the Accommodation Supplement, particularly
those on low incomes. However, because MSD does not record information on disability
and because disability, sickness and injury do not constitute eligibility criterion for these
benefits it is unknown as to the number of blind and vision impaired persons receiving
these benefits.
Through personal communication with MSD and through analysis of age cohorts in receipt
of Invalids Benefit and Sickness Benefit it is considered likely that blind and vision
impaired persons over 65 years of age would be transferred to NZ Superannuation. In
light of the assumption that New Zealanders are most likely to be affected by blindness or
vision impairment in their old age (this confirmed by both literature and the distribution of
the RNZFB membership being weighted in favour of those over 65 years) it is likely that a
significant number of blind and vision impaired persons over 65 years will be in receipt of
NZ Superannuation and are not able to be accounted for in the research.
4.3.8 Benefit Summary
The total cost of benefits and compensation paid to persons for reason of eye injury,
blindness or vision impairment is $44.4 million for the year 2002-2003. This cost does not
include individuals who for reason of blindness or vision impairment may be out of work
and therefore receiving the Unemployment Benefit nor does it include those receiving NZ
Superannuation or costs of receipt of the Accommodation Supplement. As shown in
Table 8 below, the cost of providing the Invalids Benefit for reason of blindness or vision
impairment accounts for 65% of the total benefit/compensation cost as known to blind and
vision impaired persons.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 35
Table 8: Benefit/ Compensation Cost Summary, as known, to blind or vision impaired
persons- Number in receipt and annual cost 2002-2003
Benefit/ Compensation
Number of persons in
receipt (based on
parameters in text)
TOTAL Annual cost for 20022003
Invalids Benefit
2392
$28.8m
Sickness Benefit
329
$3.2m
Sickness Benefit Hardship
14
Blind Subsidy
1
$319
Disability Allowance
1738
$2.0m
ACC (various)
4640 (cases)
$10.4m
Unemployment Benefit
unavailable
-
Accommodation
Supplement
unavailable
-
NZ Superannuation
unavailable
-
TOTAL Cost
$44.4m
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 36
5.
EPIDEMIOLOGY
5.1 Introduction
The following section estimates the number of blind and vision impaired individuals living
in New Zealand and provides future incidence estimates.
The estimates are structured by the World Health Organisation’s (WHO) Classification of
Visual Performance (Colenbrander, 1977). This framework categorises vision impairment
according to visual acuity and field of vision. Three broad categories of visual
performance are defined:
1. Normal: (6/4-6/18 visual acuity, 180-80 degrees field of vision)
2. Low Vision (6/24-3/60 visual acuity, 60-15 degrees field of vision)
3. Blindness (6/150-No Light Perception visual acuity, 10-0 degrees field of vision).
The Classification of Visual Performance provides an internationally accepted definition of
blindness and vision impairment relating to scientifically measured variables rather than
qualitative assessments of vision.
A variety of blind and vision impaired New Zealand estimates exist in the public arena, but
no organisation collects information regarding visual acuity and field of vision for every
New Zealander. The current study has relied on the following sources for estimates of
blind and vision impaired New Zealanders:






Royal New Zealand Foundation of the Blind Membership Database;
Statistics New Zealand Disability Survey 2001;
Vision Education Agency National Database for Learners who are Blind and Vision
impaired;
Land Transport Safety Authority Driver Licensing;
Anecdotal data from New Zealand ophthalmologists; and
Price Waterhouse Coopers and Diabetes New Zealand Incorporated (2001).
Other sources investigated include client records from the National Health Index, Health
Insurers, Low Vision Clinics and individual optometrists and ophthalmologists. These
organisations indicate that individual records are not easily accessible and time, financial
and confidentiality issues prevented the release of data.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 37
5.2 Final Estimates of New Zealand Blind and Vision impaired
Populations (June 2004)
Each of the data sources discussed throughout this section measures blindness and
vision impairment using different definitions. At the low end of the spectrum the RNZFB
membership data indicates that there are 11,293 blind and vision impaired New
Zealanders in 2004. At the high end of the spectrum, the Disability Survey estimates
there were 94,600 blind and vision impaired New Zealanders in 2001.
RNZFB data is collected according to acuity and field of vision measurements recorded by
ophthalmologists. The membership criterion is visual acuity worse than 6/24. Therefore it
is known that there are 11,293 New Zealanders that fit the WHO Classification of Visual
Performance criteria for Low Vision and Blindness. However, not all New Zealanders with
significant Low Vision or Blindness will be members of RNZFB. There are a number of
reasons why individuals may choose not to access services from RNZFB. For example,
older people who have progressively lost their vision may see their vision loss as a part of
the ageing process and decide to deal with impediments in their own manner. Other
people may not want to accept that they are blind, because they perceive there is a social
stigma attached to blindness or may feel that they have no need of the RNZFB services.
The Statistics NZ Disability Survey (2001) asks respondents subjective questions to rate
their visual impairment. There is no scientific basis for respondents’ answers, which
means that optimistic blind people may say that they have little difficulty undertaking the
screening questions, whilst pessimistic vision impaired people may say that they cannot
do tasks in the screening questions at all. This means that the results from the Disability
Survey cannot be easily matched with data from RNZFB, VEA or LTSA. For example, the
Statistics New Zealand estimates of blind and vision impaired populations for children (015 year olds) of 13,200 differs significantly from the RNZFB membership (727) and the
VEA estimates (1,110), highlighting the conflict of comparing scientifically measured
variables with subjective responses to questionnaires. However, LTSA records show that
there are significant proportions (60-85%) of failed drivers licence applications in young
people (aged 15-35 years) due to poor vision. Nevertheless, government organisations
rely on these estimates for strategic policy decisions.
Anecdotal evidence from leading New Zealand ophthalmologists suggests that the
number of blind and vision impaired New Zealanders is more likely to be closer to 30,00035,000. Keefe et al (2002) estimate that New Zealand has a low vision rate of 8,600
people per million. This indicates that New Zealand would have approximately 37,600
New Zealanders with Low Vision in 2004. Keefe et al (2002) present WHO estimates of
prevalence of low vision from the Global Update 1994, which concluded that there are
three people with low vision for every blind person. Whilst this ratio varies by country, the
ratio is widely accepted for industrialised nations. This would indicate that there are
approximately 12,500 blind New Zealanders in 2004.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 38
In order to deal with the diverse estimates of blindness and vision impairment uncovered
throughout the research process, three estimates of the blind and vision impaired
population are presented.
Scenario One:
Low Estimate: 11,293 RNZFB members in June 2004. (3161 blind and 8132 vision
impaired).
Scenario Two:
Medium Estimate: 12,000 blind and 34,700 vision impaired people in 2004, a total of
46,700.
Scenario Three:
High Estimate: A June 2004 equivalent for the 2001 estimated 98,400 blind and vision
impaired New Zealanders identified by the Statistics New Zealand Disability Survey.
These scenarios are an important foundation of the current study, as costs arising from
the survey will be applied to the estimates of blind and vision impaired people to
extrapolate time and monetary costs. Due to the significant variance in the estimates of
blind and vision impaired individuals, the research team believes it is best to present a
range of estimates of the blind and vision impaired population.
5.3 Projections of New Zealand Blind and Vision impaired
Populations (2011 and 2021)
5.3.1 Analysis Methods
Statistics New Zealand provides estimates of population growth according to age, sex and
ethnic distribution to 2021. In order to estimate the number of blind and vision impaired
people in New Zealand in 2011 and 2021, we have applied the age, sex, ethnicity, visual
status ratios for 2004 to the projected populations.
5.3.2 Scenario One – Low Estimate

By 2021 the blind population will grow by 36% from 3,200 in 2004 to 4,300.

By 2021 the vision impaired population will reach 11,500, up 3,400 (42%) from
2004.

The proportion of blind people older than 65 years will increase from 56% in 2004
to 67% in 2021.

The proportion of vision impaired people older than 65 years will increase from 72%
in 2004 to 80% in 2021 (refer Figure A).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 39
Figure A: Estimated Growth in Blind and Vision impaired Population
Low Estimate (2011, 2021)
14,000
2004
2011
2021
12,000
Number of People
10,000
8,000
6,000
4,000
2,000
0-18
18-65
65+
Total
0-18
Blind
18-65
65+
Total
Vision Impaired
Age & Visual Status
5.3.3 Scenario Two – Medium Estimate

By 2021 the blind population will grow by 33% from 12,000 in 2004 to 16,000.

By 2021 the vision impaired population will reach 44,600, up 10,000 (29%) from
2004.

The proportion of blind people older than 65 years will increase from 58% in 2004
to 69% in 2021.

The proportion of vision impaired people older than 65 years will increase from 45%
in 2004 to 56% in 2021 (Refer Figure B).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 40
Figure B: Estimated Growth in Blind and Vision impaired Population
Medium Estimate (2011, 2021)
50,000
2004
2011
45,000
2021
40,000
Number of People
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0-18
18-65
65+
Total
0-18
Blind
18-65
65+
Total
Vision Impaired
Age & Visual Status
5.3.4 Scenario Three – High Estimate

By 2021 the blind population will grow by 34% from 10,900 in 2004 to 14,600.

By 2021 the vision impaired population will reach 113,000, up 25,000 (29%) from
2004.

The proportion of blind people older than 65 years will increase from 59% in 2004
to 70% in 2021.

The proportion of vision impaired people older than 65 years will increase from 46%
in 2004 to 57% in 2021 (refer Figure C)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 41
Figure C: Estimated Growth in Blind and Vision impaired Population
High Estimate (2011, 2021) Replace with High Chart
140,000
2004
2011
2021
120,000
Number of People
100,000
80,000
60,000
40,000
20,000
0-18
18-65
65+
Total
0-18
Blind
18-65
65+
Total
Vision Impaired
Age & Visual Status
Increasing proportions of blindness and vision impairment are caused by age related
macular degeneration and diabetic retinopathy in western countries. Diabetic retinopathy
is particularly important for New Zealand because of the high prevalence of Type 2
diabetes in Maori and Pacific Island populations.
Price Waterhouse Coopers and the Diabetes New Zealand Incorporated (2001) estimate
the prevalence of Type 2 diabetes will grow in the Pacific Island population by 109%, from
8,760 diagnosed cases in 2001 to 18,260 diagnosed cases in 2021. There will be a 90%
increase in diagnosed cases in the Maori population, up from 24,820 cases in 2001 to
47,070 cases in 2021. European and other ethnic groups are expected to increase by
39%, from 72,830 diagnosed cases in 2001 to 101,420 diagnosed cases in 2021. The
report estimates that for every two diagnosed cases of type 2 diabetes in 2001, there is
one undiagnosed case. This ratio is projected to remain the same in 2021.
The New Zealand Health Strategy claims that Type 2 diabetes is the leading cause of
preventable blindness in NZ. The strategy cites international studies that have estimated
70 people become legally blind every year as a result of diabetes in New Zealand, and
this number will grow in line with increases in the rate of diabetes across the population.
The Price Waterhouse Coopers report estimated that 7% of Maori, 8% of Pacific Island
and 2% of European and Other ethnic populations diagnosed with Type 2 diabetes are
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 42
likely to become blind as a complication of the disease. This means in 2021 there will be
approximately 600-1,000 cases of blindness caused by diabetic retinopathy.
Age related macular degeneration is significant in the New Zealand environment as well,
because New Zealand’s population is increasingly ageing. Whilst the blindness and vision
impairment estimates have not estimated incidence according to disease, the estimates
assume that the age related macular degeneration has the same influence on people
aged over 65 years in the future. Therefore the estimates presented in this report take
into account the influence that age related macular degeneration and diabetic retinopathy
will have on the blind and vision impaired populations overall.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 43
6.
EDUCATION AND TRAINING COSTS
This section discusses the costs of blindness associated with education and training. The
section begins by reviewing the education status of blind and vision impaired people and
the education related costs of blindness previously identified in the literature. Individual
and society costs of blindness are then examined.
As previously noted, some data on the cost of government provided education services to
blind and vision impaired students was not available for this research (please refer to the
separate document on this issue ‘Data Collection Issues Encountered During the RNZFB
Costs of Blindness Research’). In addition data on the total population of blind or visually
impaired people in education or training has also not been made available for this
research.
In order to expand costs reported in the RNZFB Costs of Blindness survey, an estimate of
850 blind and vision impaired students (from primary through to tertiary education) has
been generated using information from the VEA and Disability Support Services at the
University of Auckland. This population base figure is used throughout this section and
cannot be equated or expanded to those low (RNZFB Membership), medium
(Ophthalmologists estimate) and high (NZ Disability Survey) population base estimates
used in other sections and cost areas discussed in the report. As such comparison with
these cost areas has not been developed.
6.1 Education Status
6.1.1 Levels of Education
The Statistics New Zealand Disability Survey (2001) provides a recent indication of levels
of education amongst blind and vision impaired persons. The survey asked adults living in
households what level of education they had attained and grouped responses according
to no qualification, school qualification, post-school qualification and not elsewhere
included (Statistics NZ, 2003).
Of the 69,200 blind and vision impaired adults, 30% had no qualification, 25% had
attained school qualifications and 16% had attained post school qualifications. Males
were more likely to attain post school qualifications (20% of total males).
Of the blind population, 25% had no qualification, 38% had school qualifications and only
4% had post school qualifications. Of the vision impaired population, 30% had no
qualification, 24% had school qualifications, and 17% had post school qualifications.
In comparison to the total New Zealand population, the share of blind and vision impaired
adults with no qualification was higher than the national average (24%). Slightly more
than a third of New Zealanders indicated that they had school qualifications (34%)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 44
meaning the blind and vision impaired populations are significantly under represented in
this group. Approximately 28% of New Zealanders had post school qualifications; this
share is significantly higher than the reported 4% for blind adults and 17% for vision
impaired adults.
6.1.2 Costs of Blindness Related to Education
Previous research has discussed the costs of blindness related to education. These costs
constitute a range of barriers to education faced by the blind or vision impaired student.
The difficulty of engaging in an education process primarily structured around the written
word, as well as visual references, has been widely discussed as a major obstacle faced
by the blind or vision impaired student (La Grow & Good, 2003, RNIB, 2000; Newbold,
1987). Financial costs can include the need for special equipment and technology (RNIB,
2000), and the need to convert course materials into accessible formats (RNIB, 2000).
Undertaking tertiary education also requires the vision impaired individual to achieve a
very high level of organisation and time management as well as requiring additional time
to read course materials and prepare for classes (La Grow & Good, 2003).
Opportunity costs can include restrictions on the types of subjects which are accessible to
the blind or vision impaired student. Newbold (1987) notes a tendency for students to
take social science and humanities courses due to the additional difficulty blind and vision
impaired have with mathematical and science based disciplines.
La Grow & Good (2003) argue that more supportive systems and infrastructure within
learning institutions has resulted in a more accessible environment for blind and vision
impaired students. Improvements identified include: increased availability of paid and
voluntary readers; closed circuit television systems; larger computer screens and auditory
and tactile output systems; Brailled, enlarged or taped textbooks; the provision of course
and assessment materials formats; and, an increased flexibility in learning and teaching
processes. The authors note, however, that blind and vision impaired students still
experience a high dropout rate after the first year of tertiary study (La Grow & Good,
2003). Hodges & Keller (1999) note a similar situation for blind and vision impaired
tertiary students in America. Both studies identify a range of difficulties and costs
experienced by blind and vision impaired students in order to successfully complete
tertiary studies. These include the need to develop many skills in addition to academic
ones, for example, independent living, travel, time and money management and
communication. Transportation and mobility issues can provide additional difficulties such
as reduced time efficiency, lessened opportunities for social involvement, more limited
accommodation choices and restricted ability to move easily around the campus (Hodges
& Keller, 1999).
Both studies note that blind and vision impaired students who successfully achieve both
social and academic integration on campus are more likely to successfully complete their
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 45
tertiary education (La Grow & Good, 2003, Hodges & Keller, 1999). However, it is
recognised that blind and vision impaired students face considerable challenges in
achieving social integration. Students can become isolated on campus yet also need to
have the confidence and skills to advocate for their needs and to initiate contact with
lecturers and others. Socialisation can be further hampered by transportation and mobility
issues and the limited extent to which resources and material associated with campus
activities and events are provided in accessible formats (Hodges & Keller, 1999).
6.2 Individual Costs
6.2.1 Time Costs
Time Spent Studying
On average, students in the current research report spending 374 minutes per day
studying. This includes time attending lectures and classes as well as individual study.
Blind females spend the most time studying, 452 minutes per day with blind males under
18 years the least, at 280 minutes per day.
Of this total time, students estimate an average of 48 minutes per day are ‘additional’
minutes required because of their blindness or vision impairment (refer also: La Grow &
Good, 2003). The additional hours required for study increase with the level of education
undertaken. On average, secondary students report an additional 39 minutes per day,
polytechnic students 69 minutes and tertiary students 81 minutes.
Time Spent Traveling for Study
The time required to plan and undertake travel to and from the place of study is also
examined. Public transport is the most common form of transport used (42%) with
walking (25%), someone else’s car (17%), taxis (13%), and the school bus (4%) also
identified.
Students report an average of 47 minutes per day spent travelling to and from their place
of study. Students in urban locations (57 minutes per day) spend more time travelling on
average than students in provincial locations (46 minutes per day) who in turn spend more
time travelling on average than students in rural locations (34 minutes per day).
Table 9 presents a total cost of time spent by blind and vision impaired students in relation
to education and training, this includes both time spent studying and time spent travelling
to and from place of study. The total time cost estimated is $47,865 based on a blind and
vision impaired student population estimate of 850.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 46
Table 9: Annual Education Related Time Cost, to the Individual and Society
(Blind/ Vision Impaired Student Estimate)
Visual status
Cost to
Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
0
-
0
Vision impaired
47.9
-
47.9
Total Blind and VI
47.9
-
47.9
Blind
Time Spent Organising and Planning
Students participating in the focus group discussion report needing to be highly organised
in their planning and time management in order to complete their study requirements
(refer also: La Grow & Good, 2003, Hodges & Keller, 1999). The need to be proactive in
initiating contact with teachers and communicating specific needs is also noted. One
student comments:
“I found that I have to go to the tutor the day before, to make sure I have
[the notes] all enlarged for me. I had to be really outgoing, which I am
not very. I found it really hard coming up with the courage to go up and
ask them, even though it’s their job.” (Male Youth)
Other Time Costs
While not quantified, student respondents also note the time spent undertaking
mobility training on campus. This involves learning how to get to buildings that will
be used such as libraries, disability support offices, lecture rooms and cafeterias.
Parents of Vision impaired Children
Identifying, applying for, and ensuring access to available education funding is
reported to be time consuming for parents of vision impaired children. Parents also
report the need to spend additional time within schools to ensure that teachers fully
understand the needs of their child. This can include ensuring that their child
receives their rightful entitlements, for example the allowance of additional time
during examinations.
With mainstreaming, parents can feel an increased need to spend time within
schools as mainstream teachers can be seen as less likely to fully appreciate the
needs of their vision impaired child. One parent notes that each new teacher their
child has can require more time to be spent within the school:
“My daughter had a new Social Studies teacher and she said, ‘I can’t see
the board’ and [the teacher] said, ‘I am older than you. If I can see it, you
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 47
can see it’. All your hard work [is] just gone.” (Mother of Vision impaired
Child)
6.2.2 Financial Costs
Students
Three students report primarily travelling to their place of study by taxi. One of these
respondents reports spending an average of $156.00 a week on this travel. Cost data
was not provided by the other two respondents.
Other financial costs identified by survey respondents but not quantified include the cost of
accessible format conversion (identified by 23% of student respondents), the cost of
staying on or near campus and the cost of increased internet use.
Parents of Vision impaired Children
Parents of vision impaired children strive for their children to have access to the best
educational opportunities possible. This includes appropriate access to support and
assistance, for example, access to adaptive technology. Parents may feel best positioned
to understand their child’s development and learning needs, in turn feeling most able to
understand their child’s needs for adaptive equipment and other support. In this context,
the timing of available funding and eligibility criteria may not always be seen as
appropriately aligned to their children’s requirements. In such situations, rather than
waiting for eligible funding and provision, some parents report feeling compelled to
purchase necessary equipment themselves. Comments include:
“They fund, but they fund too late. We had bought a computer and two
years later they bought the computer and then they wouldn’t refund the
one that we bought so we have two of the damned things.” (Father of
Vision impaired Child)
“What do we do? Do we pay the money now and let her get on and do
what she will be at school doing, or do we sit around and wait for
funding? Of course the answer is that we had the money, so we did it
[but] you are never going to get that money reimbursed.” (Mother of
Vision impaired Child)
To make up for the more limited range of books available to blind or vision impaired
children, parents also report enlarging books or constructing reading resources
themselves. Personal costs in time and money are again incurred. Parents also report
being required to pay for personal training in adaptive equipment if they wish to enhance
their ability to help their children’s studies at home. Parents may also feel compelled to
personally fund additional teacher support if they feel their child is having learning
difficulties and not keeping up within the mainstream setting.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 48
Because of the need to provide more than a visual function, toys providing educational
value for vision impaired children can be more expensive than ‘standard’ toys. For
example, an audible function is required to enhance the child’s ability to interact with the
toy and therefore the educational value received from it:
“You can sell that to sighted kids in their stocking at Christmas, [stuff]
from the $2 Shop. But you can’t do that with a vision impaired child: it
means nothing to them. It has to give them some sort of feedback.”
(Mother of Vision impaired Child)
6.2.3 Opportunity Costs
Blind and vision impaired students report facing many opportunity costs throughout their
experience in the education system and the challenge of reaching their full academic
potential is commonly discussed.
Practical difficulties include the inconvenience of transporting Braille text books to and
from school and the limited portability of some adaptive equipment from the classroom to
the home environment, thereby compromising the extent to which learning can be
continued at home. Restricted access to adaptive equipment used in the classroom may
also restrict the extent to which parent’s can contribute to their child’s learning within the
home environment. One parent comments further on this:
“We have heard another child in Wellington plead with his RTV to be
allowed to take [a Mt Batten] home over the holidays…[the child] was a
gifted writer and he was not allowed to have his pencil and paper at
home.” (Mother of Vision impaired Child)
Parents who are themselves vision impaired report difficulties or inability to assist their
children with their homework. This can result in a greater burden on other siblings to help
out as well as potentially further disadvantaging the blind and vision impaired child in their
schooling.
Difficulties accessing the ‘tools’ of learning taken for granted by others are discussed by
students. The difficulty or inability to use visual references such as graphs and diagrams
is particularly noted. Visual references play a central role in education and the inability to
access these constitutes a significant learning disadvantage (refer also: La Grow & Good,
2003, RNIB, 2000; Newbold, 1987). Converting information into accessible format also
incurs time and financial costs (refer also: RNIB, 2000) and may mean information is not
available when ideally required. Students also report it can be difficult for them to engage
in other learning processes such as group work and extra curriculum activity such as field
trips. The need to attend specific adaptive technology computer training can also incur
costs such as inconvenience and reduced choice on attending mainstream courses.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 49
Students also report physical limitations in the amount of time they can study for. For
example, reading for sustained periods may result in excessive tiredness and headaches.
One student illustrates this difficulty further:
"My biggest problems were when it came to exam time because for me
studying a lot and using my eyes a lot causes headaches… I missed a few
exams and had to get consideration for quite a few. It just turned into a
vicious cycle of trying to study to get ready for the exam, but knowing
that I would have a headache because I had studied so much." (Female
Youth)
One student also discusses having less choice over where to live with close proximity to
their place of study needing to be the primary consideration in choosing their student
accommodation.
6.3 Society Costs - Education Related Subsidies, Services and
Benefits
6.3.1 Education Services- Ministry of Education
Special education for blind and vision impaired learners is mainly funded by the Ministry of
Education. Special education is “the provision of extra assistance, adapted programmes
or learning environments, specialised equipment or materials to support young children
and school students with accessing the curriculum in a range of settings” (Ministry of
Education, 2003). General funding comes from the Group Special Education division.
Development of current special education policy has been driven by two transitional
periods within the education sector – Tomorrow’s Schools (1989-1995) and Special
Education 2000 (1995-2002). The Special Education Service (SES) was established
alongside Tomorrow’s Schools as an independent crown entity contracted to the Ministry
of Education. The main role of SES was to provide “advice, guidance and support for the
benefit of people under 21 with difficulties in learning development”. Specific policy
strategies aimed to “achieve a world class inclusive education system that provides
learning opportunities of equal quality to all students”. This strategy encouraged schooling
children with special education needs at their local schools and for education decisions to
be made by local stakeholders.
Under the current policy, students with minimal to moderate needs receive funding from
the “Moderate Needs Scheme”. Funds are allocated to mainstream schools taking into
account the school setting, resources and capabilities. Learners with severe vision
impairment or blindness receive funding from the Ongoing and Reviewable Resourcing
Scheme (ORRS). Children with multiple disabilities, of which vision affects their ability to
learn as well as other challenges associated with their disabilities, are also eligible for
funding through the ORRS scheme.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 50
ORRS funds children requiring additional support while at school. Eligible children are
entitled to receive specialist intervention and support including: specialist therapy support,
paraprofessional support and additional funding for small items. There are two levels of
eligibility criteria – Very High and High. The difference between the two levels is
determined by needs for specialist involvement in educational programmes.
For vision impaired students the difference between the two ORRS criteria is that children
with Very High requirements need special assistance in all face to face communications
(Braille acquisition skills) and children with High needs may need significantly adapted
teaching methods provided by specialist teachers. Most students with low vision are likely
to be eligible for High ORRS funding at the least and the support allocated to each student
is based on the student’s current Individual Education Programme (IEP), which has been
collaboratively agreed by parents/caregivers, school and the fund holder.
6.3.2 Vision Education Agency (VEA)
The Vision Education Agency is an independent organisation that researches and
provides information about the educational needs of blind and vision impaired students.
The purpose of the agency is to ensure the advancement and effectiveness of education
services to blind and vision impaired students through collaboration with the Ministry of
Education, parents, students and other organisations within the blind and vision impaired
community.
The organisation was formally established in 1999 as a Charitable Trust with the Royal
New Zealand Foundation for the Blind. The VEA board has up to nine members
representing the voices of the New Zealand Association of Teachers with Vision
Impairment, RNZFB, Association of Blind Citizens, Tangatawhenua, and parents.
6.3.3 Homai National School for the Blind and Vision Impaired
Homai College was established in Manurewa in 1965 by RNZFB. In 2000, the school
became a state residential special school with its own elected Board of Trustees and
changed its name to Homai National School for the Blind and Vision impaired.
Homai education programmes have input from specialists such as Occupational
Therapists, Physiotherapists, Speech-Language Therapists, Music Therapists, Orientation
and Mobility Instructors, and Recreation Specialists. Specialists work closely with
teachers to support students IEPs. Each student has an IEP including relevant areas from
the expanded core curriculum in conjunction with essential education skills from the
national curriculum.
Additionally, Homai co-ordinates the Education for Living (EFL) and Kick Start
programmes. The EFL programme began in 1992 to provide young adults (14-21 year
olds) with the skills for living as full a life as possible within their homes and communities.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 51
The Kick Start programme is a residential programme for 17-21 year olds which aims to
develop skills in the following areas: social, daily living, recreation, independence,
management of finances, vocational, tertiary training, organisation, special interests and
orientation and mobility.
Homai also provides an Assessment/Training Service from birth to 21 years for young
people who have or are suspected of having a vision impairment. The data enables
informed decisions to be made concerning future placement, programme and resource
requirements for each individual. This service provides educational training for parents,
teachers and other professionals.
There are usually around 95 students attending Homai, including students attending the
Kick Start programme and preschoolers attending the Early Childhood centre. There are
40 residential students living on site.
The Ministry of Education funds student
accommodation and travel costs whilst staying at the residential facility at Homai.
In 2002, only 14% of blind and vision impaired students attended special education
schools such as Homai National School for the Blind and Vision impaired (RNZFB, 2003).
It is estimated that approximately $17m is spent per annum supporting blind and vision
impaired students within mainstream schools (RNZFB, 2003).
6.3.4 Visual Resource Centres (VRCs) and Resource Teacher Vision (RTVs)
There are 12 Visual and Sensory Resource Centres based in New Zealand’s cities. Each
centre employs Resource Teachers- Vision (RTVs) to serve their region as itinerant
teachers. The teachers support children at all levels, from preschool through primary and
secondary schools. Teachers also assist parents and mainstream staff in understanding
the “functional implications of blindness and vision impairment through their regular
contact and modelling of appropriate teaching strategies” (ERO, 2003).
6.3.5 Tertiary Education Support
New Zealand tertiary institutions have disability support offices, providing staff, resources
and equipment for all students with disabilities. The Tertiary Education Commission
monitors the number of students with disabilities at each institution, however, funding for
operating disability support services is based on the total number of students (with and
without disabilities) at the institution. In 2004, the rate of $32.18 per equivalent full time
student will be paid to each institution. This funding covers provision of services to all
students with disabilities and each individual office decides how to spend their money
based on the composition of students and the most important services or equipment
required.
There are scholarships available for students with disabilities and specifically blind and
vision impaired students. The Ministry of Education also provides Supplementary Student
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 52
Grants to assist students with disability related expenses.
Subsidy also provides a positive work incentive.
The Invalids Benefit Blind
Disability offices may provide the following services to blind and vision impaired students:
study spaces, computers with vision impairment technology, assistance with choosing
courses and departmental liaison. The University of Auckland liaises with RNZFB to
provide orientation and mobility sessions with new students. This involves showing
students around campus to places that they will frequently use, such as lecture rooms, the
library, cafeterias and the disability support office.
Tertiary institutions will be responsible for accessible format production from 2004
onwards. This may include transferring academic texts and lecture notes into electronic
versions compatible with the JAWS system, audio recording, enlarged print or Braille. The
University of Auckland has been providing this service since 1996, with the exception of
Braille, however, many students criticise the length of time it takes to convert academic
texts into accessible format. Some students have not received accessible format versions
of academic texts until after their exams have been sat at the end of the course paper.
While The University of Auckland is endeavouring to streamline this process, it is likely
that tertiary institutions undertaking this task for the first time will initially share the same
experiences.
6.3.6 Tertiary Education Commission
The Tertiary Education Commission is currently in transition, as a result information about
the number of blind and vision impaired tertiary students and the level of funding is
unavailable (please see separate document ‘Data Collection Issues Encountered During
the RNZFB Costs of Blindness Research).
Nevertheless, we know that institutions will receive a disability allowance for every
equivalent full time student in 2004 of $32.18 to provide services for disabled students.
The Ministry of Education publishes information about the number of domestic tertiary
students from 1999 to 2003. The average rate of annual growth was 5% implying that
there will be approximately 274,000 domestic tertiary students. Therefore total funding for
disability services will be approximately $9m. The value of funding directly attributed to
blind and vision impaired students is much smaller than this value however, as all disabled
students needs are met with this funding.
The number of blind and vision impaired tertiary students nationally is unknown, however,
the Foundation reports providing assistance to 61 students over the last two years. The
University of Auckland and Auckland University of Technology each had around 10-12
students in 2003 requiring support from the Disability Services Office. The University of
Auckland provided access to study spaces for disabled students, the Accessible Print
Service, two CCTVs, one Scanner, three sites with access to JAWS, five sites with access
to Zoomtext, one site with access to Supernova, library and research assistance, readers
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 53
as required, and Brailed examination papers. These services were paid for by the funding
from the Tertiary Education Commission.
6.3.7 Support and Assistance Received
Eighty five percent of students surveyed require some form of additional assistance in
order to complete the requirements of their study. All blind students require assistance as
do 75% of students who are vision impaired.
People identified as providing assistance are most commonly society2 helpers (96%), for
example, disability support people provided by the educational institution attended3. On
average, these helpers are identified as providing 784 minutes of assistance each week.
Of all the society helpers identified, 78% are paid, with all paid by society4.
Table 10 presents a total financial cost for blind and vision impaired students in relation to
education and training; this includes the cost of travelling to and from place of study and
the cost of society support and assistance, the latter being the clear cost area. The cost
of society support and assistance is entirely borne by society. The total financial cost
estimated is $5482 000 based on a blind and vision impaired student population estimate
of 850.
Table 10: Annual Education Related Financial Costs, to the Individual and Society
(Blind/ Vision Impaired Student Estimate)
Visual status
Cost to
Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
0
2,302
2,302
Vision impaired
0
3,180
3,180
Total Blind and VI
0
5,482
5,482
6.3.8 Summary of Education Costs
Costs of Blindness experienced in the Educational setting cannot be accounted for
beyond the responses and data provided by respondents to the RNZFB Costs of
Blindness Survey due to unavailability of information on the number of students within the
New Zealand Education System. This means that unlike other cost areas, the population
2
Defined to include: support person employed by education institution, government agency, respondent or family; fellow
student; flat-mate; friend; neighbour; volunteer.
3
Responses indicate that respondents generally did not consider assistance received beyond the classroom or
education institution situation. Because of this, assistance received from family members is under reported.
4
Defined to include: education institution (e.g. university/polytech) and government agency (e.g. WINZ, ACC, Ministry of
Education).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 54
base estimate provided is specific to the figure of 850, estimated using information from
the VEA and Disability Support Services at the University of Auckland.
Summary Table 11: Annual Education Related Costs, to the Individual and Society
(Blind/ Vision Impaired Student Population Estimate)
Cost Activity
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
Vision
Impaired
Blind
Vision
Impaired
Blind
Vision
Impaired
Education Time Cost
0
47.9
0
0
0
47.9
Education Financial Cost
0
0
2,302
3,180
2,302
3,180
Total ALL Costs
0
47.9
2,302
3,180
2,302
3,228
Total Cost to Groups
47.9
5,482
5,530
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 55
7.
EMPLOYMENT
This section discusses the economic and employment status of blind and vision impaired
persons, as well as the individual and social costs associated with employment,
underemployment and unemployment.
7.1 Economic and Employment Status of the Disabled
Findings from the 2001 New Zealand Disability Survey show the lower economic and
employment status experienced by all adults with a disability (Statistics NZ, 2003). In all
age groups, adults with disability are more likely than adults without disability to not be in
the labour force. In all age groups under 65 years, unemployment rates are also higher
for adults with disability than for adults without disability. In a review of overseas
literature, La Grow (2003) reports an employment rate of 32% in Britain and 50% in
America for persons identifying as having any type of disability.
People with disability in the 25-64 age group are more likely than non-disabled people to
obtain income from ACC or from a government benefit. In the 65 plus age group and
similar to most people without disability, most people with disability derive their income
from NZ Superannuation. However, people with disability were less likely than nondisabled people to derive income from wages, salary, commissions, bonuses and other
payments made by employers, or from self-employment (Statistics NZ, 2003).
In all adult age groups, people with disability are also more likely than people without
disability to live in low-income households. Adults with disability in the 25-44, 45-64 and
65 plus age groups are also more likely than their non-disabled counterparts to have low
personal incomes (Statistics NZ, 2003).
7.2 Economic and Employment Status of the Blind and Vision
impaired
The impact of blindness and vision impairment on employment and economic status has
been widely examined. La Grow (2003) in review of overseas studies notes that
employment rates for this group are typically low worldwide, estimating only 25-30% of
working age blind and vision impaired persons to be meaningfully employed in developed
countries. Curtis et al (1986) identifies the lack of suitable work as a significant issue
facing the disabled generally. Participants in this study express a desire not only to be
financially independent but also to have the experience and regular social contact which
employment provides. Newbold (1987) concludes employment and income issues to be
the greatest contributor to the difficulties faced by a blind or vision impaired person as well
as being central to their ability to achieve independence. Hanley (1992) concludes that
the majority of people with a visual impairment, including a majority of those of working
age, are not in the paid labour force. His analysis of Newbold’s 1987 study showed that
the majority of respondents relied on some form of government benefit for their income.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 56
A study by the European Blind Union (EBU) (2001) reports an average of 60%
unemployment amongst blind and vision impaired people in European countries.
Particularly high rates of unemployment are reported for Poland (87%), Hungary (77%),
Germany (72%), Denmark (69%) and Norway (98%). A recent American study showed
that persons ‘blind in both eyes’ had lower economic status to those with less severe
vision impairment and those with hearing impairments. Economic status was, however,
similar to those reporting other serious impairments such as paraplegia, hemiplegia,
quadriplegia and mental retardation (Houtenville, 2003).
Findings from the 2001 New Zealand Disability Survey show a relatively higher level of
economic and employment disadvantage experienced by those blind and vision impaired
compared to other disability types. Compared to other disabilities, the survey shows those
with a seeing disability to have the lowest level of employment and greatest likelihood of
not being in the labour force (Refer to Table 12).
Table 12: Disability Type by Labour Force Status, 2001
Disability Type
Employed
(%)
Unemployed
(%)
Not in Labour Force
(%)
Hearing
38
3
58
Seeing
24
4
71
Mobility
26
3
69
Agility
27
4
68
Intellectual
36
6
57
Psychiatric/Psychological
39
7
53
Other
41
4
54
Total
40
4
56
(Source: Statistics New Zealand, 2001 Household Disability Survey)
In a recent study of RNZFB members 39% of participants were employed while 61% were
not in employment (La Grow, 2003). However, of those unemployed, only 40% were
actively seeking employment and the unemployment rate was concluded to be 14-24%.
The higher figure included “discouraged workers”, that is, those blind and vision impaired
who said they were not seeking work, but would be interested in work if it was made
available. The lower calculation of 14% was identified as three times the national
unemployment rate of 5.3% at the same time.
Studies have also found that in addition to low levels of employment, blind and vision
impaired persons are less likely to be employed at levels that reflect their skill and
educational levels (Leonard, D’Allura & Horowitz, 1999). La Grow (2003) presents similar
findings in New Zealand with 24% of employed participants in his study believing they
worked too few hours and 30% feeling their current position was below their skill and
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 57
educational levels. Thirty-six percent of working respondents felt that due to their
blindness or vision impairment their chances for promotion were limited when compared to
others and 40% felt that their wages/salary did not reflect their level of employment (La
Grow 2003).
When the results of the study were analysed by degree of vision and gender, it was found
that males with greater vision were more likely to be in paid employment than females and
those with little or no usable vision (La Grow, 2003). Those with the least education and
those with the most education were also found least likely to be in employment.
Of employed respondents in the RNZFB study, 34% worked a maximum of 1200 minutes
(20 hours) per week, 24% worked between 1860-2400 minutes (31 to 40 hours) per week
and 29% worked more than 2400 minutes (40 hours) per week. Two-thirds (67%) felt that
the number of hours they currently worked were about right (La Grow, 2003).
7.3 Barriers to Employment
A number of studies have examined the disadvantages and barriers blind and vision
people face in gaining employment. Securing employment can be difficult due to practical
difficulties- such as going to employment agencies and accessing job vacancies (RNIB
2000) and because of stigma and discrimination (Beatson 1981). Beatson (1981) also
notes reduced job opportunities due to an inability to perform some types of jobs as a
significant barrier to some types of emplyment. Newbold (1987) also comments that it can
be difficult for blind and vision impaired persons securing work that is not of low status and
not lowly paid.
La Grow (2003) reports that 80% of respondents in the RNZFB 2002 employment study
report barriers to employment. These include discrimination, employer attitude or
ignorance and functional limitations related to their blindness or vision impairment.
The EBU (2001) also notes the range of employment obstacles faced by the blind or
vision impaired person. These include practical limitations associated with being vision
impaired, high rates of general unemployment, low job qualifications and experience,
employers’ prejudice and a less than supportive legislative and policy environment.
In addition, while blind and vision impaired workers may have academic skills, ability and
qualifications, they may lack the practical and life skills to be employable. The changing
labour market, including an overall reduction in the volume of low skilled jobs available,
may also mean relatively fewer opportunities for the lower skilled and educated blind or
vision impaired person compared to those without vision impairment.
7.4 Financial Costs of Employment
When a blind or vision impaired person is in employment, direct financial costs can be
incurred by the individual, the employer or society in general. These can include: required
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 58
office modifications and technology (RNIB, 2000); the need for time off work and lost
earnings due to medical appointments and treatment (Newbold, 1987); and, the additional
administration costs faced by those self-employed (Newbold, 1987). A number of studies
suggest that blind and vision impaired employees may bear some of the additional costs
of employment themselves in order to improve their employment prospects (Hanley, 1992;
RNIB, 2000).
A recent study by the RNZFB (Fitzgerald & Associates, 2003) examines the substantive
costs of supporting vision impaired staff within the RNZFB. Five main areas of extra cost
are identified: personal equipment and communication needs; the cost of converting
written materials to Braille; the need for extra administrative support; travel costs; and
training and adaptive technology needs to maintain equal access to information.
7.5 Opportunity Costs Related to Employment
Previous research has discussed the range of opportunity costs faced by the blind or
vision impaired workers. A central theme is unrealised earnings and lost income potential
typically experienced by the blind or vision impaired individual (Newbold 1987).
Beatson (1981) has noted how the difficulties of finding employment can lead to a selfperpetuating cycle of failure, self-doubt and lack of confidence, leading to a lack of
motivation to seek employment. He also observes there can be financial disincentives to
seek employment because of impact on benefits and subsequent income.
Hanley (1992) identified that 54% of respondents in Newbold’s 1987 study felt that their
visual impairment had resulted in a loss of earnings or job. Almost half (48%) reported
difficulty obtaining employment and 84% said they would like to do jobs that they couldn’t
because of their vision impairment. Three quarters of those 20-39 years and 86% of
those 40-59 reported that their vision impairment had negatively affected the amount of
money they earned.
If work is secured, blind and vision impaired employees can face limited upward mobility
because of the type of work that is typically found (Newbold 1987, Beatson, 1981).
Newbold (1987) also notes that employers and colleagues can have lower expectations of
blind and vision impaired workers. Such perceptions can further limit the scope for
personal development and promotion. The RNIB (2000) also discusses barriers to career
building, promotion and limited access to further training.
Chou et al (2003) note the loss of labour and talent to society as a result of blind and
vision impaired persons being unable to find work, or, having lost their job. The potential
lost production of partners, family, friends and carers who support the blind or vision
impaired individual is also recognised as a loss to society in the same way. The authors
calculate the average cost of lost production of carers to the Australian society to be
A$181.43 per month.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 59
La Grow’s (2003) recent study of employment amongst RNZFB members also examines a
range of opportunity costs related to employment. Based on respondents’ own
perspectives of their employment situation, findings are mixed. Just over two thirds of
respondents (67%) felt that the number of hours they currently work was about right and
just over half (56%) felt their rate of pay was about right. Forty percent felt their rate of
pay was “a bit too low” or “way too low”. When compared to the average take home pay,
79% felt there their pay was a bit, or way below this amount (La Grow, 2003).
Seventy percent of respondents felt that their present position was about right, while 30%
felt their position was “a bit too low” or “way too low” for their ability and qualifications.
Only 39% of employed respondents felt that their opportunity for advancement in their
workplace was about the same as their peers. Over a third (36%) felt their opportunities
were “a bit worse” or “way worse” than their peers while 26% felt them to be “a bit better”
or “a lot better” (La Grow, 2003).
7.6 Individual Costs
Twenty percent (n=40) of all survey respondents in the current research were employed.
Of these, 38% were in full time employment, 35% were in part-time employment and 28%
were self-employed.
Because of the relatively small numbers, survey findings in relation to employment are
provided as actual, un-weighted numbers of respondents.
7.6.1 Financial Costs
Travel to and from Work
Eleven respondents report that they walk to work. Other forms of transport used include
travelling in someone else’s car (n=7), public transport (n=6), taxi (n=4) and own car
(n=3). Taxi user’s report an average weekly spend of $104.50 on taxis ($130 for those
blind, $79 for those vision impaired). Accounting for the Total Mobility subsidy, the
average personal weekly cost to all users travelling to and from work is $60.25. Taxi
users in the prime working age group of 18-65 years have an average personal weekly
spend of $72.00 while those less than 18 years have an average weekly spend of $25.00.
Users who are blind spend on average approximately $10 more a week than those vision
impaired.
Travel within Work
Of all employed respondents, 15 are required to travel as part of their employment. Travel
within someone else’s car (n=5) or by taxi (n=4) is most common. For those travelling by
taxi, an average weekly spend of $38.33 is reported.
Of respondents using transport other than taxis, seven report receiving driver assistance.
Identified drivers include partners, work colleagues and specifically provided drivers. An
average of 623 minutes of travel assistance is received each week (125 minutes each
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 60
working day). Four of these respondents report that the travel assistance provided is
specifically allocated to meet their requirements. In two cases, the cost of this assistance
is provided by the employer, in one case by a government agency and in another by the
individual, who is self employed.
Total Annual Employment Travel to Work Financial Costs, 2004
Total annual work related travel costs for the Foundation membership is estimated at
$498,000. This includes the cost of taxi travel not funded by subsidies (such as Total
Mobility) and the cost of any employment related travel borne by the individual. The
survey recorded no taxi costs incurred by society; the level of funding from the Total
Mobility Scheme is discussed in a later section of the report. Under the medium
epidemiology estimates (ophthalmologist scenario) the total travel to work cost is $1.9m in
2004, and according to the high epidemiology estimates (NZ Disability Survey scenario)
the total cost is $3.8m.
Table 13: Annual Work Related Travel Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to
Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
361
0
361
Vision impaired
137
0
137
Total Blind and VI
498
0
498
7.6.2 Time Costs
Travel to and from Work
Employed respondents report an average of 38 minutes travelling to and from work each
day. Blind workers (49 minutes) spend more time on average each day travelling
compared to vision impaired workers (30 minutes).
Respondents travelling to work by car are most commonly driven by family members,
typically husbands, wives or partners. Where these drivers make a special trip to take
workers to work, family drivers spend on average 287 minutes per week driving while
society drivers spend an average 160 minutes per week.
Total Annual Employment Travel to Work Time Costs, 2004
Total annual travel to work time costs for the Foundation membership is estimated at
$110,000. This includes time spent by individuals and society assisting blind and vision
impaired to travel to their place of work. Under the medium epidemiology estimates
(ophthalmologist scenario) the total travel to work time cost is $1.1m in 2004, and
according to the high epidemiology estimates (NZ Disability Survey scenario) the total
time cost is $2.3m.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 61
Approximately 57% of total time costs can be attributed to Blind members, with the cost to
either blind or vision impaired individuals being the largest component of the total cost
experienced, at 81% ($190,000).
Table 14: Annual Time Cost of Travel to and from work, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
110
24
134
Vision impaired
80
21
101
Total Blind and VI
190
45
235
Time Working
While unable to be quantified, employed participants commonly report spending more time
fulfilling the requirements of their jobs compared to fully sighted equivalents doing similar
jobs. Reasons discussed for this include that specific activities take longer to complete,
that additional breaks may be required throughout a working day and that a more
consistent work pattern may be required to be adopted. Employed participants also report
feeling the need to work extra hours to ensure they are fulfilling their role as well as a
sighted person does, or would be expected to. One employed female focus group
participant comments:
"I work far more hours into the evening just to make sure that
things are done….[you have to] work better and harder and more
effectively to be as effective, or productive." (Employed Female)
The need to undertake work-related adaptive technology training can also result in time
and indirect financial costs. For one self-employed male participant, the need to attend
training meant forgoing income for three months. For another, it meant falling behind in
their paid work.
7.6.3 Opportunity Costs
Employment related opportunity costs identified by participants in the research include
reduced employment and career potential (refer also: La Grow; 2003, RNIB, 2000;
Newbold, 1987; Beatson, 1981), underemployment, and forgone or lost income (refer
also: Hanley, 1992).
Reduced Employment and Career Potential
Participants identify a range of factors contributing to reduced employment and career
potential. These include certain careers not being available to them (refer also: Beatson,
1981), having to modify or limit career expectations, accepting less than appropriate
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 62
employment, and limited prospects for career progression (refer also: RNIB, 2000,
Newbold 1987, Beatson, 1981). Older participants in particular report encountering active
discouragement to go onto higher learning when they were young and in the absence of
current technology, an extremely restricted range of employment options.
A young male participant notes the difficulty of building up work experience to enhance
future employment potential:
"When you are a teenager, going for a job as a Foodtown person or
something… most people find easy, [but] it is quite difficult for people
who can't see properly, and when you don't get those jobs it leads on to
getting older and having no job history and that makes it harder getting a
job in the future." (Male Youth)
Under-Employment
Once employed, participants recognise that blind or vision impaired workers are more
likely to remain in work for which they are overqualified or which does not fully extend
them (refer also: La Grow, 2003). A range of factors are identified through the research
as likely contributing to this situation: the difficulty of job searching and finding
employment in the first place; the desire to fulfil the expectations of those who assisted in
securing employment; a perception of limited opportunities and a subsequent lack of
confidence in considering an alternative; and, a sense of security in knowing that the
current employment at least accommodates the persons’ vision impairment. Further, in
order to move beyond their current employment, a qualified and skilled blind person may
require a level of support and mentoring not necessarily available to them.
One employed female participant observes:
"The job I have been doing for the last 9 months I have loved it, but
compared to what I could have been earning it is probably a lot less. I
have a [university] degree, I have spent five years training to come out
with a qualification, but I have been doing a job that someone that just
came from school, or didn't have any training, could have done." (Female
Working Age)
Participants accept that they are likely to experience discrimination in the job market.
Consequently, some report feeling pressure to demonstrate their ability to perform as well
if not better than a sighted person. This can include feeling the need to acquire more or
higher academic qualifications or being prepared to work for a period of time without pay
in order to demonstrate capacity and capability. Comments include:
"You kind of feel like you have to have more than the regular person to get
the same kind of job. It's all equal opportunities, but at the end of the day
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 63
for an employer to take on someone with a visual impairment is a lot of
work for them. It's like you have to somehow make yourself better than
the average person to be employable." (Female Youth)
"… You do have to study harder and longer and try to be better
qualified and prove you can be an effective and productive
employee in order to get a job." (Employed Female)
Loss of Income
The loss of income, both real and potential, is also commonly reported. Participants
report having to pursue alternative, lower paid career paths, being less able to pursue
potentially higher paying employment opportunities and having to give up previous
employment and income because of developed vision impairment. For example, an older
female participant was unable to continue working as a self-employed seamstress and
subsequently experienced a loss of income. A male participant with a business degree
was unable to accept higher paid work overseas because necessary support networks
would not be available for him in another country.
Self-employed participants report further examples of lost income or additional cost. In
order to be competitive, a male participant working in manufacturing is required to price
his goods equivalent to those produced by sighted equivalents. This is despite the
additional equipment and time costs he incurs during the manufacturing process. The
participant comments:
"… it takes me longer, but you cannot charge that extra time for the job
you a doing. You can only put the cost on the item you are making, equal
to the cost as if a sighted person made it. So if it takes for example four
hours to make, I have to think, 'now what would I reckon a sighted person
would do it at…" (Working Aged Male)
Self-employed participants also note the need to be highly organised with high levels of
forward planning and being more susceptible to small errors. Another self-employed
participant reports that if he runs out of materials he requires for his business, he has to
wait until some can transport him to the shop to purchase what he needs. This can mean
delays in completing work, which in turn can impact on income earned.
Parents of vision impaired children also report a loss of income and employment
opportunities usually because employment is forfeited in order to provide the level of
support their children require (refer also: Chou et al, 2003; Lukemeyer, & Smeeding, 1998;
Newbold, 1987; Meyers, Curtis et al, 1986). This can include the need to provide full time
care for the child, being restricted to part time as opposed to full time employment and the
requirement to take time off work or use holiday entitlements to fulfil care and assistance
requirements. Comments include:
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 64
“No one has any idea what to do with a blind child, and until they hit
kindergarten age, there is not really any support out there for us. I have
not worked since [daughter was born], it has just been a full-time job.”
(Mother of Vision impaired Child)
“I had a part-time job that I had to give up to help [my daughter]. They
need so much more input; you can’t be a part-time parent with them. You
have to be more than a full-time parent. So you can’t do anything else.”
(Mother of Vision impaired Child)
"My mum generally had to go for jobs that she knew she would get time
off for and when I was really young at primary school she would pick me
up from school and stuff. She had to do part-time work, she didn't feel
safe letting me walk home from school." (Male Youth)
7.7 Society Costs - Employment Related Subsidies, Services and
Benefits
7.7.1 Support and Assistance
Sixty-four percent of employed respondents (n=25) report requiring assistance from others
to complete the requirements of their job (refer also: Fitzgerald & Associates, 2003).
Blind respondents (72%) are more likely to require assistance compared to those vision
impaired (57%) as are those employed full time (72%) compared to those employed part
time (50%).
Additional administration or secretarial support (n=16) is most commonly required followed
by assistance with reading (n=8) and in fulfilling travel requirements (n=2).
Assistance is most commonly required on a daily basis (n=9) with daily assistance most
typically required for administration and secretarial support. Seven respondents require
assistance at least twice a week, five once a week and six less than once a week.
On average, respondents receive an average of 253 minutes of assistance each week.
Blind workers (265 minutes) receive slightly more assistance each week on average
compared to those vision impaired (241 minutes).
Four respondents report that the time spent providing them with assistance is specifically
paid for rather than begin provided through an existing job or activity. Three respondents
report this time being paid for by society5 at an average of ten hours paid per week. One
5
Defined to include employer; ACC; other government agency; other private agencies.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 65
respondent who is self employed, reports the time being paid by themselves and/or their
family at an average of 14 hours per week.
Total Annual Time Cost of Workplace Assistance
The application of the Foundation membership population figures (low estimate) provides
an estimated total annual time value for workplace assistance of $321,000. This figure
increases to $1.4m if the Ophthalmologist population (medium estimate) is applied and to
$3.1m applying the Disability Survey population figures (high estimate).
Table 15: Annual Cost of Workplace Assistance, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
36
13
49
Vision impaired
0
272
272
Total Blind and VI
36
285
321
7.7.2 Workplace Modifications
Twenty-one percent (n=8) of employed respondents report that modifications had been
made to their workplace to accommodate their blindness or vision impairment. These
include changes in the layout of work areas (n=4) and additional or special lighting (n=2).
Others mentioned include improved access ways to the place of employment and the
installation of air conditioning.
In all cases, modifications to the layout of the work area were paid for by the employer
while additional or special lighting was paid for by the respondent and/or their family.
Personal cost to the individual for workplace modification estimated at an average of
$72.86 for each modification.
Other supportive changes identified as being made in the workplace include modified or
different duties (n=4), modified hours or days of work (n=2), and modifications to job
responsibilities (n=2).
Total Annual Financial Cost of Workplace Modifications, 2004
The total annual financial cost of workplace modifications for the Foundation membership
(low estimate) is estimated at $9,900. Under the Ophthalmologist population estimate
(medium estimate) costs are $21,100 and under NZ Disability Survey scenario (high
estimate) the total financial cost is approximately $33,700.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 66
Table 16: Annual Financial Cost of Workplace Modifications, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
6.1
2.7
8.8
Vision impaired
0.2
0.9
1.1
Total Blind and VI
6.3
3.6
9.9
Total Annual Time Cost of Workplace Modifications, 2004
The application of the Foundation membership population figures (low estimate) provides
an estimated total annual time for workplace modifications of $480,000. This figure
increases to $3.9m if the Ophthalmologist population (medium estimate) is applied and to
$9.5m applying the NZ Disability Survey population figures (high estimate).
The major component of the total time cost is the cost to society for workplace
modifications undertaken for the vision impaired. This amounts to $420,000 or 88% of the
total time costs.
Table 17: Annual Time Cost of Workplace Modifications, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Blind
Vision impaired
Total Blind and VI
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
59.1
21
80.1
0
400
400
59.1
421
480
7.7.3 Work Bridge
Workbridge is a not-for-profit organisation contracted by government to enable people with
disabilities to participate and experience equal opportunities in the labour market.
Workbridge has been delivering work-focused services for the last twelve years and has
twenty centres nationwide. On average, Workbridge has made 3,500 job placements
annually (Workbridge Website, 2004). Services are free to both job seekers and
employers. As part of its service, Workbridge administers ‘support funds’, a government
initiative aimed at leveling the playing field to enable a client with a disability to ‘gain or
maintain employment’. Within the support funds there are three groups: Job support
yearly (for employment), Training support (for training) and Self Start (for self
employment). To be eligible various criteria must be fulfilled, but the overall aim of the
funds is to address those extra costs faced in the workplace that are unavoidable because
of disability.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 67
Between 1 June 2003 and 30 May 2004, 75 blind and 167 vision impaired persons
received financial assistance through these support funds. On average these blind clients
received $5,965 each and vision impaired clients $4, 606, providing a total support cost of
$1.2m for the period.
7.7.4 State Services Commission
Mainstream Supported Employment Programme (Mainstream) is an initiative facilitated by
the State Services Commission to enable people with disabilities to participate in
mainstream employment and ‘on the job’ training in the public sector. Mainstream was
established in 1976 and since this time over 1,000 people have participated. Mainstream
provides a subsidised salary for two years (100% in the first year and 50% in the second
year) an advice and referral service for employers and programme participants, follow-up
support and access to funding for external training (State Services Commission website:
2004). The programme is reported to have a success rate of between 55 and 65%,
measured by those programme participants who go on to maintain or find meaningful long
term employment (State Services Commission website 2004).
7.7.5 Summary of Employment Costs
Costs of Blindness experienced in relation to employment as covered in the RNZFB Costs
of Blindness Survey are summarised in Table 16 below. With regards to the costs
experienced and covered in the RNZFB Costs of Blindness survey, society costs make up
the majority of all costs accounting for 74% of all work related costs. Employment costs,
overall, are greater for vision impaired respondents than compared to blind respondents;
however, the blind population reports a higher cost in relation to work related travel.
Summary Table 18: Annual Employment Related Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Cost Activity
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
Vision
Impaired
Blind
Vision
Impaired
Blind
Vision
Impaired
Work related travel
361
137
0
0
361
137
Travel to & from work
110
80
24
21
134
101
Workplace Assistance
36
0
13
272
49
272
Financial
Cost
of
Workplace Modifications
6.1
0.2
2.7
0.9
8.8
1.1
Time Cost of Workplace
Modifications
59.1
0
21
400
80.1
400
Total ALL Costs
572.2
217.2
60.7
1093.9
632.9
911.1
Total Cost to Groups
789.4
1154.6
1544
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 68
8.
DAILY LIVING
This section discusses the costs of blindness associated with daily living. Cost areas
examined include communication, domestic and personal tasks, shopping, housing,
recreation activities and voluntary work.
8.1 Communication
8.1.1 Communication Equipment
Most respondents report using communication related equipment specifically because of
their blindness or vision impairment. Three quarters (75%) of respondents use magnifying
equipment and two thirds use a talking book player. Over a quarter (29%) use tape
recording equipment and 23% use personal computers.
Other equipment used includes computer printers (19%), Closed Circuit Televisions
(CCTV) (17%), 19-inch computer monitors (9%), OCR Scanners (8%) and Braille
equipment (6%).
Respondents over 65 years of age most commonly use magnifying equipment (85% of
respondents this age) and talking book players (75%), while relatively few use personal
computers (11%) and Braille equipment (2%). By comparison, computer use is high for
those aged less than 18 years (54%) and those 18 to 65 years (48%).
Of all the equipment items identified, 60% are reported to have been “personally
purchased”. A third were “brought by someone else or gifted”, 6% “loaned or leased” and
2% were acquired in “some other way”.
Most tape recording (81%) and magnifying (84%) equipment is “personally purchased” as
are almost two thirds (65%) of identified printers and over half (57%) of identified OCR
scanners. Talking book players (4%) and CCTV’s (31%) are least likely to have been
acquired through personal purchase. Items most likely to have been “loaned or leased”
include CCTV’s (45%) and talking book players (31%). Items commonly “bought by
someone else or gifted” also include talking book players6 (63%) as well as OCR scanners
(42%).
Most (93%) communication equipment “personally purchased” is reported to have been
paid for without any financial assistance or subsidy. Where financial assistance or a
subsidy was paid, society7 sources are reported to have provided this on all occasions.
6
Findings suggest that some respondents may have similarly interpreted ‘loan or lease’ and ‘brought or given by
someone else’.
7
Defined to include: government (general); ACC; WINZ; MoH; MoE; Workbridge; Homai School; RNZFB; employer;
friend or neighbour.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 69
Society sources are also reported to have contributed most (84%) of the equipment
identified as “brought by someone else or gifted” (the remaining 16% contributed by
family) as well as most (77%) of equipment acquired through “loan or lease” (remaining
23% contributed by family).
Focus group and in-depth interview participants note that financial support is less likely for
adaptive technology required for voluntary work. Those needing adaptive technology for
education and employment purposes are prioritised for assistance over those with
personal needs, for example, to assist with personal communication. Safety is also an
important consideration for determining disability funding priorities. Consequently,
adaptive technology for blindness is reported as never funded as a top priority. It is
reported, therefore, that it can be difficult for older people or those with needs related to
voluntary work or personal communication to get funding for things like adaptive
technology.
In situations of ineligibility, participants report the potential of being faced with substantive
personal costs for adaptive technology, including equipment up-grades.
If such
technology is unaffordable, the continuing need to use out-dated or less efficient
equipment may impact on communication activity. For example, one older participant
active in voluntary work reports that her need to continue using an outdated laptop with
reduced battery capacity limits the volume of work she can undertake outside the home.
Parents of vision impaired children identify the additional costs of ‘talking’ equipment such
as clocks, tape measures, calculators, watches, dictionaries, Braille rulers and tape
measures. The necessity of such equipment may mean 'doubling up' on existing
household utensils.
Total Annual Communication Equipment Cost
Total annual cost of communication equipment is based on an average cost of equipment
items as provided by various suppliers (please see Appendices for further detail on cost
estimates). Total annual communication equipment costs for the Foundation membership
(low estimate) is estimated at $3.3m. This includes costs incurred by the individual, their
family and society in purchasing communication equipment.
Under the medium
epidemiology estimates (ophthalmologist scenario) total communication equipment costs
are $14.0m in 2004. According to the high epidemiology estimates (NZ Disability Survey
scenario) the total cost is $29.2m.
Approximately 69% of communication equipment costs can be attributed to vision
impaired populations, with individuals paying for 66% of the costs themselves. Overall,
society supports just under half the financial costs of communication equipment.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 70
Table 19: Annual Communication Equipment Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
(000’s)
Cost to Society
(000’s)
Total Cost
(000’s)
532
690
1,222
Vision impaired
1,173
929
2,102
Total Blind and VI
1,705
1,619
3,324
Blind
Elderly (65+ years) vision impaired people account for 37% ($1.2m) of total financial costs
associated with communication equipment, followed by working aged (18-65 years) vision
impaired (22%, $724,000) and working aged blind (20%, $673,000). Blind youth (less
than 18 years) only account for 2% ($57,000) of communication equipment financial costs.
8.1.2 Computer Software
Screen magnification software such as Zoomtext is most commonly used by computer
users (42% of computer users) followed by screen reader software such as JAWS (33%).
Use of print reading (16%) and voice or speech recognition (14%) software is less
common.
Almost half (43%) of computer users report not using any of these software packages.
Screen reader software is most commonly acquired through someone else buying or
giving it (61% of this software identified). “Loan or lease” (21%) and buying it personally
(18%) are also identified.
Screen magnification software is also commonly acquired through someone else buying
or giving it (58%) with fewer loaning or leasing (24%) or buying personally (11%).
Loaning or leasing (52%) is more common for voice or speech recognition software with
someone else buying or giving it (41%) also common. Few (8%) report buying this
software personally.
Print reading software is almost totally brought or provided by someone else (92%) with
few (8%) again buying this software personally.
Most (98%) software “bought or gifted by someone else” is provided by society sources
(remaining 2% provided by family sources). All software “loaned or leased” is also
provided by society sources. Forty-seven percent of software “personally purchased” is
acquired with financial assistance or a subsidy with society sources again contributing all
the assistance provided.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 71
Total Annual Computer Software Cost
Total annual cost of computer software is based on an average cost of software as
provided by various suppliers (please see Appendices for further detail on cost estimates).
Total annual computer software costs for the Foundation membership (low estimate) is
estimated at $662,000. Under the medium epidemiology estimates (ophthalmologist
scenario) total software costs are $2.9m in 2004. According to the high epidemiology
estimates (NZ Disability Survey scenario) the total cost is $5.2m.
The costs for the vision impaired make up the major component of the total computer
software costs at 54% of the total; with costs to society being more significant (93%) than
for vision impaired individuals.
Table 20: Annual Computer Software Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
38
268
306
Vision impaired
26
331
357
Total Blind and VI
64
599
663
Working aged (18-65 years) blind account for 33% ($219,000) of total financial costs
associated with computer software, followed by vision impaired elderly (65+ years) (33%,
$215,000) and working aged vision impaired (18%, $122,000). Vision impaired youth
(less than 18 years) account for only 3% ($20,000) of computer software financial costs.
8.1.3 Braille Equipment
Respondents using Braille equipment most commonly report the use of Braille writers
(52%) and Braille embossers (41%). Fewer use electronic note takers (13%) and
computer Braille displays (8%).
A high proportion of electronic note takers (81%), Braille writers (76%) and to a lesser
extent, computer Braille displays (69%) are reported to have been brought for, or given to
users by someone else. In almost all cases, society sources as identified as having paid
for the equipment provided.
Braille embossers are most likely to have been “personally purchased” (73%) and are less
commonly “loaned or leased” (17%), or “bought or gifted by someone else” (10%). Most
(86%) embossers personally purchased are done so with financial assistance or subsidy,
with all this assistance again provided exclusively by society sources.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 72
Almost a third (31%) of identified computer Braille displays are reported to have been
“personally purchased”. Electronic note takers (19%), and Braille writers (15%) are both
less commonly purchased by the individual user.
Of the Braille writers “personally purchased”, 40% are purchased with financial assistance
or subsidy, with all this assistance again provided by society sources.
Total Annual Braille Equipment Costs
Total Annual cost of Braille equipment is based on an average cost and expert opinion on
Braille equipment as provided by various suppliers (please see Appendices for further
detail on cost estimates). Total annual Braille equipment costs for the Foundation
membership (low estimate) is estimated at $1.0m. Under the medium epidemiology
estimates (ophthalmologist scenario) total Braille equipment costs are $6.0m in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $6.9m.
The cost for blind individuals ($0.7m) is the largest contributor to total costs, at 64% of the
total; with cost to society for the blind being nearly four times the cost to the individual
overall. Braille equipment costs to the vision impaired fall predominantly on the individual
($0.4m, or 99% of total costs).
Table 21: Annual Braille Equipment Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
137
531
668
Vision impaired
378
4
382
Total Blind and VI
515
535
1,050
Elderly (65+ years) vision impaired people account for 36% ($378,000) of total financial
costs associated with Braille equipment, followed by elderly blind (34%, $355,000) and
working aged blind (30%, $313,000). No financial costs were recorded for elderly blind or
vision impaired youth. Working aged vision impaired individuals accounted for only
$4,000 financial cost related to Braille equipment.
8.1.4 Other Equipment
Other equipment commonly used by respondents includes special glasses (69% of all
respondents), mobility canes (62%), adaptive clocks, watches or alarms (43%), adaptive
telephone equipment (36%) and special lights or lighting equipment (27%).
Other equipment is commonly “personally purchased”, most notably special glasses
(91%), talking appliances (90%) and special lights or lighting equipment (90%). All lights
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 73
or lighting equipment are purchased without financial assistance or subsidy. Thirty-eight
percent of talking appliances purchased are done so with financial assistance or subsidy
as are 13% of special glasses. In almost all cases, the assistance or subsidy is provided
by society sources.
Mobility canes are more commonly “bought or gifted by someone else” (70% of canes
identified), provided in most cases by society sources. Over a quarter (28%) of adaptive
clocks, watches or alarms are also acquired in this way.
Total Annual Other Equipment Costs
Total Annual cost of other equipment is based on an average cost and expert opinion on
equipment items as provided by various suppliers (please see Appendices for further
detail on cost estimates). Total annual other equipment costs for the Foundation
membership (low estimate) is estimated at $301,000. Under the medium epidemiology
estimates (ophthalmologist scenario) total other equipment costs are $1.1m in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $2.3m.
The Other Equipment costs fall largely on vision impaired individuals ($0.2m), who pay
70% of the total cost. Cost to blind individuals comprise 21% of the total cost.
The total cost to society is nearly a quarter (25%) of the total costs for other equipment.
Table 22: Annual Other Equipment Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
63
27
90
Vision impaired
163
47
210
Total Blind and VI
226
74
300
Elderly (65+years) vision impaired people account for 54% ($164,000) of total financial
costs associated with other equipment, followed by elderly blind (19%, $58,000) and
working aged (18-65 years) vision impaired generally (14%, $43,000). Both blind youth
(less than 18 years) and vision impaired youth accounted for $3,000 of total financial costs
for other equipment.
8.1.5 Equipment Training
Over two thirds (68%) of respondents have not undertaken any training in special
equipment used by them. Training reported includes training in mobility cane use (23% of
all respondents), personal computers (8%), computer software (5%), techniques of daily
living (2%), Braille equipment (2%) and talking books (2%).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 74
Braille equipment training is identified as having the highest time cost with recipients
estimating an average of 39 days spent in training. Personal computer training is also
time-consuming. Recipients report an average of 16 days in computer training generally,
12 days for screen reader software training and 13 days for screen magnification software
training.
Recipients of guide dog training report an average of 12 days spent training while
recipients of techniques for daily living report an average of 5 days training.
Training is mostly identified as being provided by the RNZFB, Homai School, and various
government agencies and to a much lesser extent, private providers and employers.
While most respondents do not state directly paying for training received, associated costs
are reported. These are most notable for training in use of personal computers, Braille
equipment, mobility training, and guide dog training. Associated costs most commonly
include the time and financial costs of travelling to and from training. For example, 66% of
those receiving computer training report a travel time cost while 41% report a travel
related financial cost.
Time off work and lost income are also identified, however, less frequently than travel
costs. Most notably, 28% of recipients of screen magnification software training and 17%
of recipients of Braille equipment training report having time off work.
The time and financial costs of travel are particularly relevant rural respondents. For
example, most (89%) rural respondents undergoing computer training identify a time cost
from travelling. Time off work and loss of income is also reported by some rural
respondents, with these costs likely to be exacerbated by travel requirements.
Mobility training is an exception to the above with rural respondents less likely to report
time and financial travel costs compared to those in provincial and urban areas. This
result likely reflects the more local provision of mobility training and in this context, greater
travel requirements from those living in larger centres.
Total Annual Equipment Training Financial Costs
Total annual equipment training financial costs for the Foundation membership (low
estimate) is estimated at $41,000. This includes the direct financial cost to individuals
and their families, of special training in using equipment. Under the medium epidemiology
estimates (ophthalmologist scenario) total equipment training costs are $107,000 in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $208,000.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 75
Table 23: Annual Equipment Training Financial Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
24
0
24
Vision impaired
17
0
17
Total Blind and VI
41
0
41
Working aged (18-65 years) blind account for 59% ($24,000) of total financial costs
associated with equipment training, followed by elderly (65+ years) vision impaired (29%,
$12,000) and working aged vision impaired (10%, $4,000). There were no financial costs
recorded for blind youth (less than 18 years) and elderly blind. Vision impaired youth
recorded only $1,000 financial costs for equipment training.
Total Annual Equipment Training Time Costs
Total annual equipment training time costs for the Foundation membership (low estimate)
is estimated at $365,000. This includes costs to family and society in supporting and
assisting people to attend equipment training (but not the time spent by the individual).
Under the medium epidemiology estimates (ophthalmologist scenario) total equipment
training costs are $1.7m in 2004. According to the high epidemiology estimates (NZ
Disability Survey scenario) the total cost is $2.4m.
Table 24: Annual Equipment Training Time Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
183
102
285
Vision impaired
28
52
80
Total Blind and VI
211
154
365
Working aged (18-65 years) blind account for 57% ($208,000) of total time costs
associated with equipment training, followed by blind youth (less than 18 years) (20%,
$74,000), elderly (65+ years) vision impaired (8%, $29,000) and working aged vision
impaired (8%, $29,000). Elderly blind had the least time costs associated with equipment
training ($3,000).
8.1.6 Equipment Repair and Maintenance
Almost three quarters (74%) of respondents using equipment report not being required to
undertake repairs or maintenance on equipment used in the last twelve months. For
those required to do so, repairs or maintenance are most commonly reported for personal
computers (9%), talking book players (5%), CCTV’s (3%) and adaptive clocks, watches or
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 76
alarms (3%). Of these, computer repairs or maintenance is reported to be the most
expensive, on average, $575. Work undertaken on CCTV’s averages $157, talking books
$92 and adaptive clocks, watches or alarms, $32.
Repairs or maintenance undertaken are reported to be mostly paid for by respondents
with some assistance from RNZFB and government agencies also identified.
Total Annual Equipment Repair & Maintenance Costs
Total annual equipment repair and maintenance costs for the Foundation membership
(low estimate) is estimated at $489,000. This includes financial costs to the individual or
family and to society. Under the medium epidemiology estimates (ophthalmologist
scenario) total equipment repair and maintenance costs are $2.2m in 2004. According to
the high epidemiology estimates (NZ Disability Survey scenario) the total cost is $4.5m.
The costs are fairly evenly distributed between the blind and vision impaired, with the cost
to blind persons being 38% and cost to vision impaired being 62% of total costs.
Approximately 80% of the total cost falls on the individual ($0.4m). Within these costs, the
cost to the vision impaired is greater (66% of the total cost to the individual).
Table 25: Annual Equipment Repair and Maintenance Cost, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
132
51
183
Vision impaired
260
46
306
Total Blind and VI
392
97
489
Elderly (65+ years) vision impaired account for 36% ($177,000) of total financial costs
associated with equipment repairs and maintenance, followed by elderly blind (26%,
$129,000) and vision impaired youth (less than 18 years) (16%, $79,000). There were no
financial costs recorded for blind youth.
Total Communication Equipment Costs
The total communication equipment costs are estimated at $6.2m for the Foundation
membership (low estimate). Under the Ophthalmologist scenario (medium estimate) the
total cost is $28.0m and by applying the NZ Disability Survey estimates (high estimate) the
total cost is $50.7m.
Just over half (51%, $3.2m) of the total communication equipment costs are borne by the
individual, with 49% ($3.1m) being costs to society. Costs to the blind individual account
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 77
for 33% of the total costs to the individual, with the costs to vision impaired individuals
accounting for the remaining 67%.
Communication equipment costs to the blind account for 39% of total annual
communication equipment costs. Communication equipment costs for the vision impaired
are estimated at 61% of the total communication equipment costs.
The purchase of communication equipment and computer equipment is the largest cost
component ($4.0m) and comprises 64% of total communication equipment costs.
8.1.7 Opportunity Costs
Loss of Privacy
Participants commonly discuss the loss of privacy due to an inability or restricted ability to
read correspondence such as bank statements. There may be a lack of choice or control
over who reads information or delays in being able to receive information until a suitable
reader is available. The desire to impose some control over information disclosure may
result in further delays in information being communicated. One older male participant
comments:
"There are some things that I don't want my daughter or my son to know,
so I would rather get someone else to read it for me. You are just going
around and around [different people] in order to keep it private." (Male
Older Adult)
Portability
While technology advances have improved the function of communication equipment,
difficulties or limitations in using equipment can contribute further opportunity costs. The
relative lack of portability of some equipment may reduce the range of environments or
situations within which equipment can be used. For example, a lack of portability of
workplace adaptive equipment may reduce the ability to use such equipment outside the
workplace. A lack of technology within the home may also restrict ability to practice
learning, thus undermining the benefit of training courses attended. There may also be
additional physical strains in using adaptive equipment limiting the amount of time that can
be spent undertaking activities such as reading.
Knowledge and Confidence Barriers
Vision impaired persons less adaptable, able and confident in learning to use adaptive
technology are particularly vulnerable to communication opportunity costs. In an
increasingly technological society, difficulties adapting to technology can result in an
increased reliance on others, greater loss of previously undertaken communication activity
and more pronounced loss of skills and communication ability. For example, loss of
reading may lead to a reduced vocabulary, reduced ability to maintain currency in
interests and less connection and understanding of contemporary events.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 78
Location Effects
It is noted that those living outside of the Auckland area can face more limited access to
adaptive technology training, consequently requiring greater reliance on independent
learning and/or experiencing difficulties in using adaptive technology as effectively and/or
as efficiently as possible. One South Island based key informant working in voluntary
services notes:
"I had to figure out myself how to access all this sort of stuff. It was
quite hard and I still don't have access to the internet easily. It's quite
hard for me to find what I want, because half the time I can't. My
customers are not getting as good a service as they should from me."
(Female Older Adult)
Cost Barriers
Survey participants were asked unprompted whether there is any equipment,
service or support they needed but were unable to get. Equipment was raised
most often, with large screen, scanner and CCTV mentioned by 5% of total
respondents and 10% of those of working age (18-65yrs). Ninety-six percent of
these people identified cost as the key barrier here. From discussions, it also
appears likely more elderly members may not even consider some of the more
expensive communication equipment because of cost.
8.2 Domestic and Personal Tasks
8.2.1 Time Costs
Domestic Tasks
Survey respondents were asked what domestic activities they spent time on, with or
without assistance. Tasks commonly undertaken include: daily preparation of food and
drink and clearing up after meals (88% of respondents); weekly indoor cleaning, laundry
and other care of clothing (74%); and the weekly upkeep of grounds (e.g. gardening and
mowing lawns) (58%). Tasks less commonly undertaken include: household
administration (49%); looking after pets and other domestic animals (40%); and home and
vehicle maintenance and repairs (21%).
Vision impaired respondents are significantly more likely than those totally blind to
undertake all domestic tasks examined in the research. Compared to male participants,
females are significantly more likely to undertake all tasks except home and vehicle
maintenance and repairs.
On average, respondents spend a total of 150 minutes per day undertaking those
domestic tasks surveyed.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 79
Comparison with findings from the 1998/99 Statistics NZ Time Use Survey suggests that
compared to the general population, blind and vision impaired people spend less time on
average undertaking food and drink preparation and clean up, indoor cleaning, laundry
and other clothes care and home maintenance. As discussed, methodological limitations
require these findings to be considered with some caution. The findings may, however,
reflect the amount of time spent by others undertaking or supporting blind or vision
impaired persons in undertaking such activities.
It is notable that the comparison with the Time Use Survey suggests that on average,
blind and vision impaired persons spend more time on household administration
compared to the general population. There may be a number of possible reasons for this
result. Household administration may in particular be an activity which blind and vision
impaired people strive to achieve so as to maintain a level of autonomy and
independence. It may also be an activity in which assistance from others is less readily
available.
Personal Tasks
Respondents report an average of 142 minutes per day spent on personal tasks. This
includes getting dressed, attending to personal hygiene and grooming, eating and
drinking. Respondents less than 18 years spend the least time on these tasks, on
average 107 minutes per day; while those aged over 65 years spend the most time, an
average of 150 minutes per day. On average, vision impaired respondents spend 14
minutes more per day on personal tasks when compared to those totally blind.
Comparisons with the Time Use Survey findings again indicate blind and vision impaired
persons spending less time on average eating and drinking in their home compared to the
general population. Compared to the previous findings on domestic tasks, differences
are, however, less obvious and are perhaps mostly explained by the methodological
limitations of the comparison (i.e. a likely under reporting of time spent through the survey
recall method). Greater consistency between the two groups seems understandable,
particularly given that this is just a measure of time spent eating and drinking (rather than
any associated activity) and is an activity more likely to be undertaken without assistance
by the blind or vision impaired individual alone.
The ability to make comparisons in relation to personal hygiene and grooming is limited
due to differences in questioning. The Costs of Blindness Survey included time spent
getting dressed in this question whereas the Time Use Survey only included personal
hygiene and grooming. Compared to the general population, the Costs of Blindness data
shows more time spent by blind and vision impaired persons undertaking personal
hygiene, grooming and dressing. Given the additional activity included in the Costs of
Blindness question, this result is not surprising. However, the extent of the difference,
particularly for some demographic sub-groups, is notable and suggests that even in
accounting for time spent dressing, blind and vision impaired individuals may spent more
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 80
time on personal hygiene and grooming compared to the general population. Such
activities are likely to be undertaken independently by blind and vision impaired persons, a
situation consistent with the likelihood that these tasks will take longer to undertake when
compared to a sighted person.
Participants generally perceive domestic duties to take longer for someone with vision
impairment when compared to sighted equivalents. For example, when ironing, the
removal of wrinkles may need to be felt rather than observed. Identifying, using and
replacing ingredients can substantially impact on the amount of time spent cooking. The
difficulty of assessing progress in domestic tasks can also lead to over-cleaning (refer
also: RNIB, 2000) and the unnecessary repetition of tasks. Time and financial costs can
subsequently be incurred. Participant’s comments illustrate these costs further:
"My husband is partially sighted. He seems to take tons longer
mowing than my brother, or if my mother did it. He's out there
three quarters of an hour and mum will whip around in fifteen to
twenty minutes. I think it's because he's going over the same
thing." (Employed Female)
“…housework, it takes you at least twice as long because if you’re
vacuuming a floor, you’ll go over an area more than you need to, to
make sure that it’s clean.” (Female Older Adult)
Parents of vision impaired children recognise their children’s lack of vision as a major
impediment to their learning of daily living tasks such as dressing, grooming, using the
telephone and eating. One participant comments:
“The biggest thing, over and above everything is the time to teach our
children simple daily techniques of daily living…It took me six weeks of
morning, noon and dinner to get [my child] to drink through a straw.”
(Mother of Vision impaired Child)
Total Annual Domestic Tasks Time Costs, 2004 (excluding shopping)
Total annual time costs associated with domestic tasks around the home (excluding
shopping) are estimated at $19.5m for the Foundation membership (low estimate). This
includes time costs to the family and society in providing help and support - not paid for by
the individual. The cost activities covered in the survey include: preparing meals,
cleaning, laundry, gardening, home maintenance and repairs, help with personal care
(dressing, hygiene, grooming) looking after pets and help with household administration
(paying bills, reading mail etc).
Under the medium epidemiology estimates
(ophthalmologist scenario) the total time costs associated with domestic tasks is $77.8m
in 2004. According to the high epidemiology estimates (NZ Disability Survey scenario) the
total cost is $168.3m.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 81
Of the total costs, the domestic task costs to vision impaired persons ($12.2m) comprise
62% of the total.
Table 26: Annual Time Cost of undertaking Domestic and Personal tasks, to the Individual
and Society (Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
7,327
0
7,327
Vision impaired
12,183
0
12,183
Total Blind and VI
19,510
0
19,510
Elderly (65+ years) vision impaired account for 39% ($7.5m) of total time costs associated
with domestic tasks, followed by working aged (18-65 years) blind (28%, $5.5m) and
working aged vision impaired (20%, $3.9m). Blind youth (less than 18 years) have the
least time costs associated with domestic tasks at $181,000 (1%) this may be more likely
a reflection of life-stage and the likelihood or parents and caregivers assisting as opposed
to a lack of cost experienced.
8.2.2 Support and Assistance Required
Survey respondents were asked whether they require assistance to undertake domestic
tasks around the home. Tasks most commonly requiring help include: indoor cleaning,
laundry and other care of clothing (54% of all respondents); looking after grounds,
including gardening and mowing lawns (53%); home and vehicle maintenance and repairs
(46%); and household administration (47%).
Help is less commonly required for food and drink preparation and cleaning up (22%),
personal care (11%) and looking after pets and other domestic animals (6%).
When compared to vision impaired respondents, blind respondents are significantly more
likely to require help with food and drink preparation and cleaning up, looking after
grounds, household administration, looking after pets and other domestic animals and
attending to personal care.
Of all persons identified as providing domestic assistance, 62% are defined as family8
helpers and 38% as society9 helpers. On average, family members provide 290 minutes
8
Defined to include: Husband; wife; partner; family/whanau member.
9
Defined to include: Helper employed by government agency; Helper employed/provided by private agency; Helper
employed by respondent or family; Flatmate; Friend or neighbour; Volunteer; Other.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 82
of assistance in a typical week while society helpers provide 174 minutes of weekly
assistance. Compared to vision impaired respondents, blind respondents receive on
average, 72 minutes more of family provided assistance per week and 146 more minutes
of society provided assistance per week.
8.2.3 Financial Costs
All family provided assistance with domestic tasks is unpaid while 80% of society helpers
are paid for their assistance. Of society helpers who are paid, 95% are paid for by
society10 sources while 5% are paid for by both the respondent and/or family and society
sources.
In total, 42% of all respondents report a personal cost to either themselves or their family
for domestic help received. Respondents who are totally blind (46%) are significantly
more likely to experience a personal cost compared to vision impaired (40%). On
average, reported personal costs for domestic assistance are $75.24 per month. Average
monthly costs are similar for vision impaired ($74.87) and totally blind ($76.08)
respondents. Rural respondents have a higher monthly average cost ($101.06) compared
with those in urban ($71.84) and provincial ($60.43) locations.
Focus group participants report that families are less likely to pay for domestic assistance
when family members are available to assist. Subsidies for domestic assistance are also
generally only available to those living alone or without family support. If home assistance
is funded, limited availability and flexibility in provision may still require additional
expenditure or further draw on voluntary assistance. Where there is ineligibility for paid
assistance or unpaid assistance is not readily available, personal payment for relatively
simple tasks such as minor repairs and personal grooming may be required. Participants
comment:
"Now I am going to a chiropodist, I cannot see to cut my own toenails. I
cut the tops of my toes off last time, one of them anyway. My eyebrows
need plucking, so I will have to go and [pay for that]. I have to have my
hair done. I used to do it myself." (Older Adult, Female)
“When you own your own home, one of the ongoing costs is gardening
and mowing lawns. You have to pay someone to do it. And also every
three to five years you have to get your house painted and guttering and
roof. It’s just ongoing.” (Working Aged Male)
Other domestic related costs identified by focus group participants include the potential for
higher incidences of breakages around the home and for some, additional electricity bills
10
Defined to include: government agency; private agencies; other.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 83
due to increased need for lighting. It is noted that a combination of old age and vision
impairment can result in a greater chance of dropping things, falls and injury within the
home. Higher grocery bills due to food spillage and wastage is also suggested, with one
participant estimating this extra cost to be in the region of 30% of total grocery spend.
Some participants report increased use of dry cleaning in order to ensure that clothes are
properly cleaned and appropriate levels of personal appearance maintained. Restricted
ability to make, modify or repair items around the home may also result in greater or more
frequent expenditure.
Parents of vision impaired children report having to buy special equipment for the home,
for example, high chairs and equipment to help with toilet training. Shoes and clothing
may also be more expensive due to the need to accommodate their children’s needs (e.g.
shoes with Velcro rather than standard shoelaces).
Total Annual Domestic Assistance Financial Costs
Total annual financial costs associated with domestic tasks are estimated at $13.1m for
the Foundation membership (low estimate). This includes costs incurred by the individual
in paying for help and assistance and to society in providing support. Under the medium
epidemiology estimates (ophthalmologist scenario) the total time costs associated with
domestic tasks is $44.4m in 2004. According to the high epidemiology estimates
(Disability Survey scenario) the total cost is $78.4m.
Table 27: Annual Financial Cost of undertaking Domestic and Personal tasks, to the
Individual and Society (Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
1,464
4,328
5,792
Vision impaired
3,061
4,286
7,347
Total Blind and VI
4,525
8,614
13,139
Elderly (65+ years) vision impaired account for 49% ($6.4m) of total financial costs
associated with domestic tasks, followed by working aged (18-65 years) blind (26%,
$3.5m) and elderly blind (13%, $1.7m). Vision impaired youth (less than 18 years)
account for the least financial costs associated with domestic tasks (1%, $112,000) and
may again be more reflective of lifestage.
8.3 Shopping
8.3.1 Shopping for Groceries
Seventy-eight percent of all survey respondents report that they shop for groceries, with or
without assistance. Vision impaired respondents (80%) are slightly more likely to go
shopping than those blind (74%).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 84
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 85
8.3.2 Time Costs
Focus group participants generally perceive that getting to the supermarket and doing the
shopping takes them longer due to their vision impairment (refer also: Newbold, 1987).
Survey respondents report an average of 143 minutes per week shopping for groceries
with blind respondents spending on average an additional 42 minutes per week shopping
compared to those vision impaired.
Total Annual Shopping Time Costs, 2004
Total annual time costs associated with shopping are estimated at $5.3m for the
Foundation membership (low estimate). This includes time costs to the family, neighbours
and friends in assisting with shopping. Under the medium epidemiology estimates
(ophthalmologist scenario) the total time costs associated with shopping is $20.3m in
2004. According to the high epidemiology estimates (NZ Disability Survey scenario) the
total cost is $44.6m.
Table 28: Annual Time Cost of doing Shopping, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
1,472
0
1,472
Vision impaired
3,838
0
3,838
Total Blind and VI
5,310
0
5,310
Elderly (65+ years) vision impaired account for 52% ($2.7m) of total time costs associated
with shopping, followed by working aged (18-65 years) vision impaired (17%, $926,000)
and elderly blind (15%, $806,000). There are no time costs recorded for blind youth (less
than 18 years) associated with shopping.
8.3.3 Support and Assistance
Approximately 69% of respondents who shop for groceries report that they require help to
do so. Of all helpers identified, 61% are family helpers while 39% are society11 helpers.
Family helpers provide an average of 116 minutes of shopping assistance per week.
Society12 helpers provide much less assistance each week, on average 67 minutes. On
average, blind respondents receive 69 more minutes of family provided help each week
compared to vision impaired with regards to shopping.
11
Defined to include: flatmate; friend; neighbour; volunteer; employee at supermarket/shop; taxi driver; driver of public
transport; helper employed by government agency; helper employed by respondent/family.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 86
All family helpers are unpaid while 25% of society helpers are paid. Ninety four percent of
paid society helpers are paid for by society13 sources while 6% are paid for by both the
respondent or their family and society sources.
Overall, only 3% of all respondents report a personal cost for the help they receive doing
shopping, on average, $25.52 per week.
Shopping Undertaken by Someone Else
Of those respondents who do not shop for groceries (22% of all respondents), almost half
(49%) do not do so because of their vision impairment. The likelihood of not shopping
increases with age and is significantly more likely if blind as opposed to vision impaired.
All non-shoppers require others to shop for them. Of those undertaking this shopping,
72% are family helpers and 28% are society helpers. Family shopping helpers spend on
average 140 minutes per week shopping with all this time being unpaid. Society shopping
helpers spend on average 62 minutes per week shopping. Just over two thirds (68%) of
society shopping helpers are paid, in cases by society sources.
8.3.4 Financial Costs
The restricted ability to take advantage of sales and specials is commonly identified by
participants (refer also: RNIB, 2000). In total (unprompted and prompted) 41% of all blind
and vision impaired shoppers (78% of all respondents) feel they ultimately pay more for
goods purchased because of this disadvantage. Difficulties in becoming aware and then
taking advantage of advertised sales and specials are commonly discussed. Comments
by participants include:
"[I am not able] to go through the circulars that everybody gets in
their box, or read in the paper. So you just stick to what you might
know… (Employed Female)
"Some of these sales might be 20% discount on say $100 or $200that is $40 off. But quite often it can cost that to get there. So what
was the point? You might as well buy it from the shop across the
road instead of [paying] $160 and a taxi." (Working Aged Male)
The blind or vision impaired shopper may face further disadvantages generally in
accessing cheaper goods. In total (unprompted and prompted) 29% of shoppers feel they
pay more for goods because they are less able to shop at supermarkets and other
discount stores. Access to such stores may be difficult or may require substantial
transport planning. For manageability, there may be a tendency to purchase items from
shops closest to home with such stores not necessarily offering the cheapest option.
13
‘Society’ here includes: government agency (e.g. ACC, Ministry of Health services) or other private agency.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 87
People upon whom the blind or vision impaired shopper may rely to select goods may not
always pay full attention to price. The blind or vision impaired shopper may themselves
inadvertently select the more expensive option without recognising this.
Blind and vision impaired shoppers can also find it difficult to fully evaluate the condition
and quality of produce purchased as well as use by dates. Both difficulties can increase
the possibility of wastage and further indirect financial costs.
Unprompted, 15% of survey respondents identify the cost of transport to and from shops
as an additional financial cost faced.
Total Annual Shopping Financial Costs
Total annual financial costs associated with shopping are estimated at $1.9m for the
Foundation membership (low estimate). This includes costs to the individual and families
in paying for assistance and costs to society in providing assistance. Under the medium
epidemiology estimates (ophthalmologist scenario) the total financial costs associated with
shopping is $6.1m in 2004. According to the high epidemiology estimates (NZ Disability
Survey scenario) the total cost is $12.4m.
Financial costs associated with shopping are funded mainly by society (95%).
Approximately 66% of financial costs associated with shopping can be attributed to vision
impaired populations.
Table 29: Annual Shopping Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000s)
Cost to Society
($000s)
Total Cost
($000s)
Blind
51
599
650
Vision impaired
50
1,234
1,284
Total Blind and VI
101
1,833
1,934
Elderly (65+ years) vision impaired account for 58% ($1.1m) of total financial costs
associated with shopping, followed by working aged (18-65 years) blind (17%, $327,000)
and elderly vision impaired (17%, $323,000). There are no financial costs recorded for
blind youth (less than 18 years) associated with shopping.
8.3.5 Opportunity Costs
Opportunity costs identified in relation to shopping include less purchasing choice, a more
limited range of products purchased and reliance on others (refer also: Newbold, 1987). A
central theme within the findings on shopping is that shopping trips and purchase
decisions are typically determined by accessibility and manageability rather than price,
needs, preferences, or even spontaneity.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 88
Many factors contribute to having less choice in purchasing decisions. These include
reduced access to information to inform purchasing decisions, inability to read product
labels and ingredients and difficulty seeing the full range of products on offer. Product
selection may be further limited through restricting purchases to a limited range of known
brands and less opportunity to try new goods. Furthermore, there may be fewer
opportunities to try new products because of limited access to information notifying their
availability.
The vision impaired shopper may also limit their shopping to specific stores where they
know and trust the shop assistants. While this may reduce the difficulties experienced
with shopping, it can further limit choice and variety in shopping.
Unassisted, supermarket shopping can be particularly difficult for the blind and vision
impaired shopper due to the self-selection nature of this form of shopping. In order to
manage with this requirement, the selection of goods may be based on familiarity with the
positioning of goods within regularly used shops. However, shopping by ‘route’ may
further limit selection and product choice. Furthermore, the re-positioning of items within
the store can undermine previous learning, requiring further time to relearn new
positioning.
Because of the difficulties encountered, the timing of shopping trips may need to be
carefully considered, for example, conscious avoidance of shopping centres during
particularly busy periods. In total (unprompted and prompted) 44% of survey respondents
report that they are unable to shop at particular times or places because of their vision
impairment. Shopping trips may also be limited and a number of shopping tasks
attempted in each trip. This may reduce the ability to be as selective and discerning in
shopping, with the goal being to achieve as much as possible in one shopping trip.
Reliance on others is another central theme within the findings on shopping. In total
(unprompted and prompted), 58% of shoppers recognise their inability to shop when
and where they desire as a cost of blindness. The blind or vision impaired shopper
may be reliant on others for transport, guidance around the store, product
evaluation and selection, purchasing, and putting goods away when back home.
Reliance on others can result in less flexibility and freedom in planning shopping
exertions. For example, the timing of shopping trips may be fully dependent upon
access to sighted helpers, such as family, friends or trusted taxi drivers. Even a trip
to the local dairy, a shopping exertion taken for granted by most sighted people,
may be totally dependent upon the availability of support people. One participant
comments:
"There is a dairy probably 50 metres in the distance, but I can't get to it
because you have to cross the street, and that would be straight out
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 89
suicide for me. So I have to wait until I know that somebody that we
know is passing that way." (Working Age Male)
8.4 Housing
8.4.1 Financial Costs
Home Modifications
Survey respondents were asked whether they had been required to make any
modifications to their home because of their blindness or vision impairment. Modifications
reported include: additional safety features (24% of all respondents); contrasting features
(21%); additional or special lighting (20%); additional security features (14%); erected
fences (7%); and structural changes to the house (5%). Less commonly reported
modifications include improving access ways to the house, removing corners, bathroom
alterations, tinted windows, additional rooms added and the removal of loose item/fixtures
within the house.
Focus group and in-depth interview participants also discuss
undertaking modifications such as safety railings, new paint to improve visual contrasts,
safety strips on steps and additional, often high wattage lighting. One participant
comments:
“We had 1 quite big expense moving into this place…. [new house] had a
patio off the sitting room…was quite high up….[with] no railing or steps
off it…[putting up railings] was one of the first things we had to do…Had I
been a sighted person, I could probably have left it like it was”. (Older
Adult, Female)
Of all modifications identified, the respondent and/or their family paid for the majority
(77%) of modifications, with society14 paying for 20% of those identified. Modifications
commonly paid for the respondent and/or their family include additional or special lighting
(94%), contrasting features (93%), additional safety features (83%) and putting up fences
(81%). Society sources were most likely to pay for additional safety features with 69% of
these modifications paid for by society sources.
Respondents identifying costs for home alterations report an average personal cost of
$621.40.
Participants note that even when house renovations are undertaken by choice rather than
necessity, additional costs can be experienced due to less ability to undertake some or all
of this work personally. One participant comments:
“...We’ve just had [renovations] done in the flat we’ve bought… It’s cost us
about $15,000 to do the upgrading we wanted to do… it could have been a
14
‘Society’ here includes: government (general), ACC, WINZ, MOH, RNZFB or other private agency.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 90
lot cheaper if [partner] could have done quite a lot of it himself.” (Older
Adult, Female)
Total Annual Housing Financial Costs
Total annual housing financial costs are estimated at $65,000 for the Foundation
membership (low estimate). This includes costs for home modifications to the individual
and society. Under the medium epidemiology estimates (ophthalmologist scenario) the
total housing financial costs are $973,000 in 2004. According to the high epidemiology
estimates (NZ Disability Survey scenario) the total cost is $2.3m.
Of the total financial costs for housing, individuals meet the majority (98%) of costs, with
cost to blind respondents for home alterations being 22% of the total costs and vision
impaired bearing the greatest portion of the cost burden, accounting for 78% of total costs
to the individual.
Table 30: Annual Housing Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
65
2
67
Vision impaired
235
4
239
Total Blind and VI
300
6
306
Elderly (65+ years) vision impaired account for 63% ($193,000) of total financial costs
associated with housing alterations, followed by working aged (18-65 years) blind (19%,
$59,000) and working aged vision impaired (14%, $44,000). There were no financial
costs associated with housing alterations recorded for blind youth (less than 18 years).
Location of Housing
The need to secure accommodation close to amenities such as shops, public transport,
medical services, work and schools is discussed by some participants (refer also: BCA,
2000, Newbold, 1987). It is perceived that suburbs and houses offering such benefits are
generally more expensive to purchase or rent within. There may also be a need to stay in
more expensive areas because necessary support systems have been built up in the area
over time. This can be particularly important for older adults who may rely heavily on their
familiarity with local amenities and services as well as locally established support
networks.
The need to accommodate seeing-eye dogs may also limit rental accommodation choices
(Newbold, 1987) as well as potentially adding further costs, for example, erecting and
maintaining fences. Vision impaired parents may also face the additional requirement of
fencing properties in order to ensure the safety of their children. If such fencing cannot be
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 91
afforded, children may face limitations in the extent to which they are able to play
outdoors.
8.4.2 Time Costs
Twenty six percent of respondents identify having received unpaid assistance in making
modifications to their home, on average receiving 298 minutes of unpaid assistance.
Total Housing Time Costs
Total annual housing time costs are estimated at $14,000 for the Foundation membership
(low estimate). This includes costs of unpaid assistance received in carrying out
modifications. Under the medium epidemiology estimates (ophthalmologist scenario) the
total housing time costs are $76,000 in 2004. According to the high epidemiology
estimates (NZ Disability Survey scenario) the total cost is $179,000.
Table 31: Annual Time Cost of undertaking Home Alterations, to the Individual and
Society (Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
0
4
4
Vision impaired
0
10
10
Total Blind and VI
0
14
14
Working aged (18-65 years) vision impaired account for 50% of total time costs associated
with housing alterations, followed by elderly (65+ years) vision impaired (29%, $4,000)
and working aged blind (21%, $3,000).
8.4.3 Opportunity Costs
Reflecting the previous findings, less choice and flexibility in accommodation decisionmaking is commonly reported. For example:
"Automatically as soon as you buy a house in any suburb closer to the
amenities it costs you more. There were some suburbs they just weren't
an option to me, because I couldn't be close enough to the things that I was
familiar to.” (Working Age Female)
"I could move out further from the Central City, out to West Auckland or
South Auckland or whatever. Even though it would be cheaper, I just
don't feel comfortable about going. I wouldn't know where I was and
there wouldn't be as good public transport." (Male Youth)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 92
"[Nana] could have had a nice little retirement fund, in that big house, but
she has had to stay where she is - she needs us [close by]." (Granddaughter
of Older Adult)
Participants also report constraints on the extent to which they can experience new living
or lifestyle arrangements. This can include restricted ability to live outside of cities due to
more limited access to necessary services. Youth report that it can be difficult to move
from the family home, due to difficulties finding appropriate flatting arrangements. Parents
with vision impaired children also note that moving can be particularly difficult for their
children. Difficulties can include the need to break supportive relationships built up
between children and their teachers as well as removing the child from the local
surroundings they have grown accustomed to. Such constraints may also have financial
implications. For example, while being aware that it would be cheaper to move and rent in
another suburb, one mother reports feeling unable to do this because of the level of
familiarity her child had developed within their current location. This connection was
crucial to the level of independence the child had established and it was recognised that a
move would be highly retrograde for the child.
8.5 Recreation Activities
Respondents report undertaking a variety of recreation and leisure activities. Activities
identified by 5% or more of respondents include: sports activities (60%); reading, including
talking books (56%); social activities with family and friends (41%); social groups (41%);
television (36%); music related activities (33%); gardening (27%); computer games and
the internet (12%); craft activities (11%); puzzles, games, cards (10%); cooking (8%); and
attending movies, concerts, performances (9%).
Particularly common activities undertaken by blind respondents may reflect the reduced
mobility and socialisation commonly experienced with blindness. Compared to vision
impaired respondents, blind respondents are significantly more likely to: undertake craft
activities; play with pets; write or record letters; participate in music related activities; and
read and listen to talking books. All are activities commonly undertaken within the home
and often on an individual basis. By comparison, vision impaired respondents are
significantly more likely to: undertake voluntary work; engage in sports activities; socialise
with family and friends; and attend movies, concerts and other performances.
Reduced or loss of participation for the blind in activities requiring functional abilities are
also reflected in the findings. Compared to blind respondents, vision impaired are
significantly more likely to; garden; play computer games or use the internet; play puzzles;
games and cards; and undertake DIY projects and other activities around the home .
8.5.1 Financial Costs
Over a quarter (29%) of respondents report requiring special equipment to participate in
recreation and leisure activities. Blind respondents (33%) are significantly more likely to
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 93
require special equipment than vision impaired (28%). Consistent with this finding,
increasing likelihood of need is also shown with increasing age.
Equipment required by 5% or more of respondents include: talking book equipment (57%);
magnifiers (15%); walking or mobility cane (14%); special lightning (11%); glasses (10%);
modified cards and games (7%); and cell phones (5%).
Total Recreational Financial Costs
Total annual recreation financial costs are estimated at $4.0m for the Foundation
membership (low estimate). This includes costs to the individual in paying for support
received and to society in helping.
Under the medium epidemiology estimates
(ophthalmologist scenario) the total recreational financial costs are $21.5m in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $38.4m.
Of the total financial costs for recreation, society bears the majority (92%) of cost, with
blind persons experiencing 38% of the total costs and vision impaired the greater portion
at 62%.
Table 32: Annual Recreation Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
147
1,371
1,518
Vision impaired
178
2,307
2,485
Total Blind and VI
325
3,678
4,003
Elderly (65+ years) vision impaired account for 34% ($1.4m) of total financial costs
associated with recreation, followed by working aged (18-65 years) vision impaired (26%,
$1.0m) and vision impaired youth (less than 18 years) (15%, $613,000).
8.5.2 Support and Assistance
Half (51%) of those respondents undertaking recreation and leisure activities report
requiring assistance from others in order to participate in such activities.
The provision of guidance and assistance during the activity undertaken is commonly
required (62%) as is the need for transportation to and from the activity (62%). Other
requirements include directions or assistance in getting to the activity (9%), specific
training or instruction (3%) and assistance with reading (2%).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 94
Of those people identified as providing assistance with recreation and leisure activities,
61% are identified as society15 helpers and 39% as family helpers. On average, society
helpers spend 124 minutes per week providing assistance and most (91%) helpers are
unpaid. On average, family helpers spend 239 minutes per week providing assistance
with recreation and leisure activities. All family helpers are unpaid. Those respondents
and/or their families contributing to or fully paying the cost of society helpers incur an
average monthly cost of $37.67.
Total Recreational Time Costs
Total annual recreation time costs are estimated at $4.4m for the Foundation membership
(low estimate). This includes time spent by the individual and their family in undertaking
recreational tasks and getting to and from tasks. Under the medium epidemiology
estimates (ophthalmologist scenario) the total recreational time costs are $15.8m in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
time cost is $35.4m.
The individual and their family bears all time cost associated with recreation. The vision
impaired population reports a greater cost, accounting for 72% of total recreation time
costs.
Table 33: Annual Recreational Time Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
1,231
0
1,231
Vision impaired
3,211
0
3,211
Total Blind and VI
4,442
0
4,442
Vision impaired females aged 65 years and older bear 43% of all recreation time costs
reported. Respondents living in rural areas report the least recreation time costs, with
only respondents (either blind or vision impaired) aged 18-65 years and vision impaired
females aged 65 years and older reporting a recreation time cost. Those living in
Metropolitan and Provincial areas reported greater cost by comparison, perhaps reflective
of greater recreational opportunities, facilities and services may be more readily available
in these areas.
8.5.3 Opportunity Costs
Opportunity costs identified by research participants include the loss of ability to undertake
recreational activities and reduced choice in the range of feasible recreation options (refer
15
Defined to include: member of social club; member of sports club; flatmate; friend; neighbour; volunteer; private
organisation; general public
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 95
also: Kelly, 1995). With vision impairment, activities that once may have been freely
engaged in become more difficult, often to the point where they are no longer undertaken
and/or where essential elements or benefits of the activity are lost. Participant comments
include:
"You never plan when you retire that you are going to be blind… you think
that you will be out gallivanting [around]… bit of this and that and
popping around garden centres. And you just can't do those things
anymore…” (Female Older Adult)
"I walk you see, but I don't walk for pleasure unless I walk with
somebody, because I don't know where I'm going really. I'm only
three minutes from the beach, but to get down onto the beach, you
have to clamber over a lot of rocks and I wouldn't ever do that by
myself, it's too dangerous. When I had no more friends to walk
with me, I stopped walking down the beach." (Female Older Adult)
The need to consider safety issues in recreational pursuits can also result in additional
costs. For example, in order to be able to exercise alone, yet with safety, some
participants report that they were required to join gyms; a decision they may not have
made if they were sighted and had other options for safe forms of exercise (e.g. walking or
jogging). Certain recreational activities may also simply be unavailable because of safety
issues connected to vision impairment.
Further barriers to participation may be experienced due to limited access to information
about the availability of events and activities. New, unknown or particularly challenging
activities may be avoided simply because of the associated difficulties of undertaking such
endeavour. The anticipated attitude or reaction of sighted others within groups may also
provide a considerable disincentive to participation.
Parents of vision impaired children note that additional time and money can be spent
finding recreational and sporting activities that are appropriate and enjoyable for their
children. Once such activities are identified, additional travel may be required in order to
access them. Ensuring that their children do not miss out on experiences may also incur
additional costs, for example, needing to pay for more expensive tickets at live
productions so that their children are closer to, and therefore more likely to benefit from,
and enjoy, the performance. Parents also note that it can be difficult for their children to
engage in recreational activities or training in a group situation. Activities such as horse
riding, swimming and music are identified as generally requiring individualised as opposed
to group tuition, typically at additional cost. One parent comments further:
“You can’t get a kid that is blind getting into a public pool to have a lesson,
they are just totally disoriented. You ask her to swim to the other side of
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 96
the pool, well where is that? She needs that one on one where it’s a quiet
surrounding and she can find out where she needs to go.” (Mother of
Vision impaired Child)
“We go to a play group on a Friday, we live in West Auckland and we
travel all the way to the North Shore to be with peers for the children,
then our children go to Homai Pre School which is South Auckland.. the
transportation and the time is unbelievable.” (Mother of Vision impaired
Child)
8.5.4 Recreation and Social Activity
Survey respondents were asked whether there were any activities or pursuits they would
like to participate in, or do so more often. For anything nominated respondents were then
asked why they were unable to do so. Seventy one percent of respondents could
nominate at least one activity they'd like to undertake, or pursue more often.
Table 34: Recreation Activities would like to participate in or do more often
Activity persue more often
Respondents(%)
None
29
Sport (various)
43
Drive a car/ ride a motorbike
13
Craft and Art activities
9
Go on a trip/ Travel
8
Puzzles/ card games
7
Read
5
Join a club/ group
3
Go to the Movies
3
Travel Alone/ Do things without assistance
3
Play an instrument
3
More Gardening
2
Go to sports matches/ watch sport
2
Generally be more active
2
Go for walks
2
Go to Music festivals/ concerts/ community events
2
Use a computer
1
Check out new shopping malls
1
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 97
The main barrier to participation/ increased participation in identified activities is the
experience of blindness or vision impairment, this being cited by 68% of respondents.
Lack of confidence (15%) and cost (14%) are also commonly mentioned. Time taken to
organise and plan for the activity (9%) and lack of access to necessary support and
assistance (6%) are also contributing factors.
8.6 Voluntary Work
Twenty five percent of survey respondents report undertaking some form of voluntary
work. Vision impaired respondents (26%) are slightly more likely to undertake voluntary
work compared to those blind (23%).
Of all age groups, respondents over 65 years are least likely to undertake voluntary work
(18%), however, by virtue of their total numbers; they contribute the greatest proportion of
total voluntary workers (49%). This finding suggests increasing difficult to engage in
voluntary work with increasing age increasing vision impairment. Comments from a
number of older adults involved in the research support this:
"I gave it up because I was finding that I was doing the job okay, but I
was thinking it was difficult for me to see all the things that people were
going to look at, like gardens and museums. I find that is something that
is taken away from me and I can't do anymore." (Female, Older Adult)
Those volunteering do so most commonly on a weekly basis (55%).
volunteer on a daily basis, 8% monthly and 25% less than monthly.
Eleven percent
Compared to vision impaired respondents (7%), blind respondents (26%) are significantly
more likely to volunteer on a daily basis while vision impaired respondents are more likely
to volunteer weekly (59% c/f 44%).
Compared to all other age groups, those under 18 years are significantly more likely to
undertake voluntary work on a daily (20%) or weekly (80%) basis. This finding may reflect
high numbers of young people engaged in voluntary work as a means of gaining work
experience.
On average, blind and vision impaired volunteers report contributing 227 mins of voluntary
work each week. On average, blind volunteers (334 minutes) contribute 142 more
minutes of volunteer work each week compared to those vision impaired (192 mins).
Respondents to the Statistics NZ Time Use Survey report spending an average of 32
minutes per day, or 224 minutes per week, on unpaid or voluntary work outside of the
home. Clearly, blind and vision impaired people are contributing as much time to society
for free as the general population.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 98
Total Voluntary Work Financial Costs
Total annual financial costs associated with voluntary work are estimated at $320,000 for
the Foundation membership (low estimate). This includes costs to family and society in
supporting the blind and vision impaired person to carry out voluntary work. Under the
medium epidemiology estimates (ophthalmologist scenario) the total voluntary work
financial costs are $1.6m in 2004. According to the high epidemiology estimates (NZ
Disability Survey scenario) the total cost is $3.6m.
Of the total financial costs for voluntary work, society bears the majority (99%) of the cost,
with the blind volunteer worker costs being 43% of the total costs and vision impaired
57%.
Table 35: Annual Voluntary Work Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
3
135
138
Vision impaired
0
182
182
Total Blind and VI
3
317
320
Working aged (18-65 years) vision impaired account for 50% ($160,000) of total financial
costs associated with voluntary work, followed by working aged blind (42%, $135,000) and
elderly (65+ years) vision impaired (4%, $13,000). There are no financial costs associated
with voluntary work recorded by blind youth (less than 18 years).
8.6.1 Support and Assistance Required
Almost one third (31%) of blind and vision impaired volunteers require assistance from
others in order to undertake their voluntary work. Blind volunteers (42% require
assistance) are significantly more likely than vision impaired volunteers (27%) to require
assistance.
Transportation to and from voluntary work commitments is the assistance most commonly
required (50% of volunteers), followed by assistance with administrative tasks (33%),
undertaking the voluntary task itself (23%) and reading support (6%).
Of all people identified as providing assistance, 75% are society16 and 25% are family
helpers. On average, both society and family helpers provide 52 minutes of assistance
16
Defined to include: member of social club; member of sports club; flatmate; friend; neighbour; volunteer; private
organisation.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 99
each week. All family helpers are unpaid while a quarter of society helpers are paid, in all
cases by society17 sources.
Total Voluntary Work Time Costs
Total annual time costs associated with time voluntary work are estimated at $5.9m for the
Foundation membership (low estimate). This includes costs to individual for the hours
worked voluntarily and costs of time contributed by family members to help the blind and
visually impaired people to do volunteer work. Under the medium epidemiology estimates
(ophthalmologist scenario) the total voluntary work time costs are $29.9m in 2004.
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $66.7m.
Table 36: Annual Voluntary Work Time Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
2,326
0
2,326
Vision impaired
3,622
0
3,622
Total Blind and VI
5,948
0
5,948
Working aged (18-65 years) vision impaired account for 37% ($2.2m) of total time costs
associated with voluntary work, followed by working aged blind (25%, $1.5m) and elderly
(65+ years) vision impaired (17%, $1.0m).
8.6.2 Summary of Costs Associated with Daily Living
Costs of Blindness experienced in relation to daily living as covered in the RNZFB Costs
of Blindness Survey are summarised in table 35 below. The Blind population experience
the greatest proportion of total cost, accounting for 67% of the total cost associated with
the tasks of daily living. The greatest daily living cost area is in undertaking domestic and
personal tasks, accounting for over half (55%) of all costs associated with daily living.
17
Defined to include: government agency (e.g. ACC, MoH); private agencies; RNZFB; social club; sports club.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 100
Summary Table 37: Annual Costs of Daily Living, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Cost Activity
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
Vision
Impaired
Blind
Vision
Impaired
Blind
Vision
Impaired
Communication
Equipment
532
1,173
690
929
1,222
2,101
Computer Software
38
26
268
331
305
357
Braille Equipment Cost
137
378
531
4
668
382
Other Equipment
63
163
27
47
91
210
24
17
0
0
24
17
Equipment TrainingTime Cost
183
28
102
52
285
80
Equipment
repair/maintenance
132
260
51
46
184
306
Total Equipment Costs
1,109
2,045
1,669
1,409
2,779
3,453
Equipment
Financial Cost
Training-
Total Equipment Cost to
Groups
3,514
3,078
6,232
Domestic Tasks- Financial
Costs
1,464
3,061
4,328
4,286
5,792
7,347
Domestic
Cost
Tasks-
Time
7,327
12,183
0
0
7,327
12,183
Total Domestic
Costs
Task
8,791
15,244
4,328
4,286
13,119
19,530
Total Domestic
Cost to groups
Task
24,035
8,614
32,649
Shopping- Financial Costs
51
50
599
1,234
650
1,285
Shopping- Time Costs
1,472
3,838
0
0
1,472
3,838
Total Shopping Costs
1,523
3,888
599
1,234
2,122
5,123
Total Shopping Cost to
groups
5,411
1,833
7,245
Housing-Financial Costs
65
235
2
4
67
239
Housing- Time Costs
0
0
4
10
4
10
Total Housing Costs
65
235
6
14
71
249
Total Housing Cost to
groups
300
20
320
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 101
RecreationCosts
Financial
147
178
1,371
2,307
1,518
2,486
Recreation- Time Cost
1,231
3,211
0
0
1,231
3,211
Total Recreation Costs
1,378
3,389
1,371
2,307
2,479
5,697
Total Recreation Cost to
groups
4,767
3,678
8,176
Voluntary Work- Financial
Costs
3
0
135
182
138
182
Voluntary
Costs
Work-
Time
2,326
3,622
0
0
2,326
3,662
Total Voluntary
Costs
Work
2,329
3,622
135
182
2,464
3,844
Total Voluntary
Cost to groups
Work
Total ALL Costs
Total Cost to Groups
5,951
14,111
25,390
39,501
317
9,479
9,432
18,911
6,308
22,073
37,171
59,244
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 102
9.
TRANSPORT AND MOBILITY
The following section considers the costs of blindness in relation to transport and mobility.
Please note that this section does not include transport associated with employment or
education. Transport to and from work and place of study or travel within work is
considered in the Employment (section 7) and Education (section 6) sections.
9.1 Individual Costs
9.1.1 Financial Costs
Short Distance Travel
Almost all (98%) respondents to the Costs of Blindness survey report travelling short
distances18 in the last twelve months. Forms of transport most commonly used to do this
include some else’s car (75% of all respondents), walking (62%), taxis (57%), public
transport (40%), and own car (34%).
While only 9% of taxi users use taxis everyday or almost everyday, 67% of taxi users
aged less than 18 years use taxis on a daily basis. In comparison, only 8% of users 18 to
65 years and 6% of users over 65 years use taxis everyday or almost everyday.
Over a third (35%) of taxi users use this transport mode once a week or more, while
approximately one in five (19%) use taxis once a month or more. Over a third (37%) of
users use taxis less than once a month.
Rural respondents use taxis less frequently than those in provincial and urban areas. Over
half (57%) of rural users use taxis less than once a month. Only 18% of rural respondents
use taxis once a week or more and none use them everyday or almost everyday. This
may be due to the likely higher cost of taxi travel in rural areas, due to perhaps further
travel distances when compared to provincial or urban areas. Lack of use in rural areas
may also represent a lack of readily accessible taxi services.
Taxi users report spending an average of $27 a week on taxis. Users under 18 years of
age spend an average of $59 a week. While travelling by taxis less frequently, rural users
($27) spend on average more than urban users ($22), however, less than provincial users
($33).
Accounting for Total Mobility subsidies, average additional weekly spend for those using
taxis amounts to $15 per week. Previous differences by sub-groups are still apparent with
those under 18 years of age spending on average the most ($40 per week). Differences
between urban ($13), provincial ($17) and rural ($15) locations are also still apparent.
18
If employed or a student, excludes travel to and from work or place of study
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 103
All respondents travelling short distances in the last 12 months were asked either why
they had not used taxis at all or why they had not used taxis more frequently over the last
12 months. Forty-four percent report not needing to use taxis any more frequently while
29% report cost as the main reason. Cost is a particularly common barrier for those aged
18 to 65 (42%) as well as urban respondents (42%). Other reasons identified for not
using taxis or not using them more frequently include having someone else available to
drive (5%) and taxi services being unavailable in the location lived in (4%).
While cheaper public transport options may be available, the difficulties of using such
transport can mean that these options are less than feasible. Difficulties can be
experienced walking to and from stops, identifying the appropriate service to catch as well
as connecting services. Some participants also discuss their safety concerns about
getting on and off vehicles such as buses. When there is a need to ensure punctuality, for
example, getting to work, the potential for delays and difficulties may be considered too
great and taxis then relied upon. People also report leaving very early to allow additional
time to cover any potential difficulties, to ensure punctuality. Some participants also report
favouring taxis to cope successfully with new or unfamiliar trips or when a trip would
require a number of connecting public transport services. Comments include:
“…compared with the time it would take to catch a bus I don’t mind
paying, but then I have this thing, ‘Oh my god, I have had x number of
taxis this week and it has cost me this many dollars….But I will still much
rather take a taxi. What makes me decide to take them is that the whole
process of taking the bus is pretty full-on at times.” (Female Youth)
“…I had to get someone to look after my children while I went, like after
school while I was in [another city] training. That’s a cost to the family.
They might pay your travel, but there are always extraordinary costs
involved, like getting the taxi to the train station”. (Female Older Adult)
A sense that the constant feeling of reciprocal obligation is suggested as a cost in itself for
those highly reliant upon others for transportation:
"I can't just hop in a car and drive myself, so I have to pay somebody to
take me there and pay somebody to bring me back. Always paying and
that has been my life." (Working Age Male)
Total Short Distance Travel Financial Costs
Total annual financial costs associated with short distance travel are estimated at $4.6m
for the Foundation membership (low estimate). This includes costs to the individual for
taxis not covered by the Total Mobility subsidy. Under the medium epidemiology
estimates (ophthalmologist scenario) the total financial costs are $21.4m in 2004.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 104
According to the high epidemiology estimates (NZ Disability Survey scenario) the total
cost is $39.6m.
Table 38: Annual Short Distance Travel Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
1,374
0
1,374
Vision impaired
3,267
0
3,267
Total Blind and VI
4,640
0
4,640
Elderly (65+ years) vision impaired account for 54% ($2.5m) of total financial costs
associated with short distance travel, followed by blind youth (less than 18 years) (12%,
$563,000) and working aged (18-65 years) vision impaired (12%, $537,000). Vision
impaired youth account for the least financial costs associated with short distance travel
(4%, $204,000).
Long Distance Travel
Over two thirds (69%) of respondents report having undertaken long distance19 travel in
the last twelve months. Rural respondents (83%) are most likely to have travelled long
distances, compared to those in provincial (66%) and urban (60%) areas.
Over three quarters (77%) of those who travel long distances report requiring assistance
to make such trips. The requirement for assistance is high for those blind (83%) as well
as for those living in rural areas (94%).
9.1.2 Time Costs
Reliance on others for transportation is reported to result in substantial time costs for the
blind or vision impaired traveller. For example, time can be lost waiting for arranged
transport to arrive or needing to delay activities until transport is available. Planning the
efficient use of one’s time can also be difficult if movements are reliant upon the
availability of drivers. Comments from participants in the research include:
"You spend a terrible lot of time waiting about, waiting to be picked up."
(Male Older Adult)
"My eldest [child] is eighteen and she drives me. But if she is an hour late,
that is nothing to her, whereas I'm sitting there for an hour waiting for her
to come and pick me up." (Working Age Female)
19
Travel over 80km
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 105
"… That is a cost in itself, waiting.
arguments." (Male Older Adult)
That means frustration and
If travelling by public transport, additional time can be incurred planning the trip, identifying
and making connecting services and getting to and from pick up points. Aligning
appointments with public transport schedules may also mean significant amounts of time
having to be dedicated to a single appointment.
Inevitably, the need for transport assistance translates to time costs for those providing
this assistance. Survey respondents travelling in some else’s car or their own car most
commonly identify family members (40%) as those driving them. Respondents under 18
years of age are particularly reliant on family members as drivers (69% of respondents
this age).
Other drivers commonly identified include wives (19%), husbands (14%), friends (15%),
neighbours (6%), drivers employed by the respondent and/or their family (4%) and
volunteers (3%). On average, family drivers are reported to spend 126 minutes a week
driving and society drivers, 112 minutes per week. Parents of vision impaired children
report transportation comprising a significant time cost for them and one not necessarily
likely to reduce as children get older.
Public transport is also typically less available and frequent in smaller centres resulting in
greater reliance on family and friends for transportation. Limited public transport options
may mean having no option but to use taxis. Limited services to and from smaller centres
may also require overnight stays in areas otherwise not wished to be undertaken. Limited
rail services in smaller centres may also mean that the bus is the only feasible long
distance travel option for the vision impaired, an option, however, providing a number of
potential difficulties (e.g. negotiating stops and toilet requirements).
Blind parents may also face a greater requirement to walk to after-school or weekend
activities, incurring extra time costs to do this. Getting children to activities generally
inevitably requires substantial planning and effort, be the transport mode walking, taxis, or
public transport. Because of their transport difficulties, blind parents also note less ability
to leave children at activities and do something else during the time the children are
occupied. Having to stay at the activity until it is completed can result in a loss of time for
other activities to be carried out and less ability to have time out from their children. One
participant who was a parent comments on this further:
“…There is no provision for time out. As I said, sighted people could drop
kids off at the kindergarten for the afternoon, but if it took you half an
hour to walk to the kindergarten and then stay with them, it would take
you half an hour to walk home again.” (Female Older Adult)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 106
Total Short Distance Travel Time Costs
Total annual time costs associated with short distance travel are estimated at $13.1m for
the Foundation membership (low estimate). This includes costs for time spent by family
and society in driving for blind or vision impaired persons. Under the medium
epidemiology estimates (ophthalmologist scenario) the total time costs are $63.8m in
2004. According to the high epidemiology estimates (Disability Survey scenario) the total
cost is $132.9m.
Table 39: Annual Short Distance Travel Time Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
3,006
963
3,969
Vision impaired
5,936
3,148
9,084
Total Blind and VI
8,942
4,111
13,053
Elderly (65+ years) vision impaired account for 39% ($5.1m) of total time costs associated
with short distance travel, followed by working aged (18-65 years) vision impaired (25%,
$3.2m) and elderly blind (13%, $1.7m).
9.1.3 Opportunity Costs
Transport related opportunity costs identified in the study include restricted ability to travel
when and where as desired, the loss of ability to travel independently, and reduced time to
undertake other activities.
“…I think people as a whole like their independence. They want to move
when they want to move. You’ve got to move when they say move.”
(Female Older Adult)
Reliance on public transport can severely restrict movements and result in a loss of
flexibility in travel decisions. For example, planning longer distance travel may be totally
based around public transport schedules and connecting services.
The cost of taxis can require being selective in what trips are undertaken, potentially
leading to further opportunity costs. One mother discusses the impact of this further:
"With the children now we have coffee groups occasionally, and I do still
weigh it up, 'even with half price it's going to cost me $35 return. Should I
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 107
go or should I skip this one, or go to every second one?’ So I think it
results in lost opportunities because of that." (Working Age Female)
A blind parent also notes reduced opportunities to link into existing parent support
networks as a result of being unable to contribute to such networks, for example, a car
pool. Restrictions on the range of activities that could be undertaken as parents with their
children are also identified.
Thirty-two percent of survey respondents report not having travelled long distances (trips
more than 80kms) in the last 12 months. Of these 56% report their blindness or vision
impairment as stopping them from undertaking long distance travel. Difficulties identified
with travelling centre around a lack of someone to help, difficulties with boarding and
alighting from planes, trains and buses and the distance and difficulty of getting to an
airport.
9.2 Societal Costs of Transport Related Benefits and Subsidies
9.2.1 Total Mobility Scheme
The Total Mobility Scheme (TMS) is a subsided Taxi scheme run by Transfund New
Zealand in conjunction with participating regional councils throughout New Zealand. The
programme is designed to address issues of mobility for disabled persons by improving
access to taxis and making them more affordable.
As of 2003, the typical level of subsidy is 50% although some regional schemes are run
differently. For example, the Northland scheme provides a 50% subsidy for the first half of
the year with a 25% subsidy being made available for the latter part. All regional councils
have their own restrictions on the service such as minimum and maximum fares or travel
distances able to be travelled. In some regions, the service excludes certain geographical
areas.
Users of the scheme are typically provided with a set number of subsidy vouchers to last
them the year. Blind or vision impaired Total Mobility users would usually access the
scheme through their local RNZFB branch. Alternatively the scheme may be accessed via
the regional council’s Total Mobility co-ordinator. Most regional councils require users to
carry a Total Mobility identification card issued by either the RNZFB or the Total Mobility
co-ordinator.
Annual Cost of the Total Mobility Scheme
In calculating the annual cost of the Total Mobility Scheme to both blind and vision
impaired individuals and society, information was collated using Transfund’s 2003 survey
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 108
of the scheme. Direct communication was also undertaken with individual regional
councils. The amount of information available and the level of detail that could be
provided is unique to each regional council. Table 40 summarises the information
available on total numbers of blind and vision impaired users of the scheme by regional
council:
Table 40: Blind and Vision Impaired Users of the Total Mobility Scheme (2002)
Regional Council
Total Number of
Scheme Users
Total Number of
Blind/ VI
Scheme Users
Proportion of Scheme
Users who are
Blind/ VI (%)
Auckland
9,184
2,303
25.1
Waikato
1,791
182
10.2
800
52
6.5
2,736
332
12.1
609
n/a
-
Hawkes Bay
1,089
n/a
-
Taranaki
1,200
24
2.0
Man/ Wanganui
3,500
630
18.0
Wellington
7,787
766
9.8
Malborough
185
49
26.5
Nelson/ Tasman
606
n/a
-
Canterbury
5,443
667
12.3
West Coast
900
13
1.4
2,022
328
16.2
868
96
11.1
38,720
5,442
14.1
Northland
Bay of Plenty
Gisborne
Otago
Southland
National TOTAL
Table 38 shows that in 2002 there were 38,720 Total Mobility Scheme users of which
5,442 or 14% were blind or vision impaired users. In Malborough and Auckland, blind and
vision impaired persons comprise a large portion of total Total Mobility Scheme users
(26.5% and 25.1% respectively). By comparison, blind or vision impaired users comprise
a relatively small proportion of users in the West Coast and Taranaki regions (1.4% and
2.0% respectively).
The annual cost of the Total Mobility Scheme is shared by both the regional council and
Transfund New Zealand. As of 2002, Transfund incurs 40% of the cost with the Regional
council funding 60%. In 2002, the scheme cost regional councils and Transfund a total of
$7.4m.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 109
While blind and vision impaired users of the TMS comprise a particular proportion of total
users in each region, this proportion does not necessarily correspond to their total use of
funds. Blind and vision impaired total mobility users use less funding than would
correspond with their portion of the total population. The following table (Table 39)
summarises the total cost for 2002 experienced by Transfund and regional councils in
subsidising taxis for blind or vision impaired users:
Table 41: Cost to Society of Blind/ Vision Impaired users of the Total Mobility Scheme
(2002)
Regional Council
Cost of Blind/ VI
Scheme Users
($)
Average Cost
per Blind/VI
Scheme User
($)
Average Cost per
Non-Blind/ VI Scheme
Users (*= All Users)
($)
Auckland
391, 153
170
321
Waikato
23,620
130
179
Northland
6,100
117
152
Bay of Plenty
n/a
-
133*
Gisborne
n/a
-
66*
Hawkes Bay
n/a
-
152*
Taranaki
n/a
-
182
Man/ Wanganui
39,000
62
156
Wellington
91,000
119
151
Malborough
4,438
91
225
Nelson/ Tasman
7,000
-
218*
Canterbury
101,800
153
239
West Coast
n/a
-
78*
Otago
32,400
99
206
Southland
15,596
162
239
National TOTAL
712,107
131
192*
The total annual cost to society of blind and vision impaired users of the Total Mobility
scheme in 2002 was $712,107, with an average cost per blind or vision impaired user
being $131. This compares with an average of $192 for non-blind/ vision impaired users.
With the subsidy typically standing at 50% it is conceivable that individuals would
therefore have faced the same annual costs in 2002, therefore doubling the total
expenditure on taxi fares.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 110
9.2.2 Public Transport Subsidies
Various public transport concessionary fares are offered to disabled persons throughout
New Zealand. Administered by local authorities, a general concession is often provided to
beneficiaries, senior citizens, and the disabled, although specific details again differ
across the country.
As of 2003, in Auckland, North Shore and Waitakere, blind passengers are able to travel
on bus, train and ferry services on a senior citizen fare. A special photo ID is required for
such concessions. Wellington City Council offers a general discount to beneficiaries and
anyone over 60 years of age. The concessionary fares are, however, only available off
peak (so not before 9am or between 4pm and 6pm). ID is also required. The minimum
saving is $0.20 and the maximum saving available is $2.10. Nelson City council has a flat
fare of $1.50 for beneficiaries, senior citizens and the disabled.
Information on blind and/ or vision impaired users uptake of these concessionary fares is
unavailable in that, as users they are grouped in with other persons (e.g. senior citizens,
other disability groups).
9.2.3 Summary of Costs Associated with Transport and Mobility
Costs of Blindness experienced in relation to Transport and Mobility (excluding travel
associated with employment or education- please see sections 7 and 6 respectively) as
covered in the RNZFB Costs of Blindness Survey are summarised Table 42 below. The
Individual and their family bears the greatest cost in relation to Transport and Mobility
costs, accounting for 77% of total costs. Greater cost is also experienced by the vision
impaired population when compared to blind counterparts.
Summary Table 42: Annual Costs of Transport & Mobility, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Cost Activity
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
Vision
Impaired
Blind
Vision
Impaired
Blind
Vision
Impaired
Travel- Financial Costs
1,374
3,267
0
0
1,374
3,267
Travel- Time Costs
3,006
5,936
963
3,148
3,969
9,084
Total ALL Costs
4,380
9,203
936
3,148
5,343
12,351
Total cost to groups
13,583
4,084
17,694
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 111
10. SOCIAL COSTS OF BLINDNESS
10.1 Introduction
The extent to which blindness and vision impairment results in social costs for both the
individual and society should not be underestimated. Anecdotal evidence suggests a
range of costs including an increased rate of relationship failure, family difficulties,
depression, and loss of social connectiveness amongst others.
While there is need to acknowledge the social costs of blindness, the current study is
limited in its exploration of these. There are two main reasons for this: firstly, the research
methodologies primarily employed in the study were considered to be largely
inappropriate for examining social costs; and, secondly, there were questions over
whether such data collection was ethically warranted within the context of current study.
Collecting information on social costs was only considered ethical if a process existed
through which such findings could be effectively used to address those costs identified.
While such data may have been able to identify unmet social service needs within
members, such an evaluation was considered to be beyond the scope, mandate and
resources of the current research.
However while limited examination of social costs was undertaken, two common themes
relating to social costs do emerge from the research findings. These are the loss of
independence and difficulties achieving social integration. Each theme is discussed
further below.
10.1.1
Loss of Independence
Loss of independence as an outcome of blindness and vision impairment has been
illustrated in many of the previous research findings. Such loss is commonly experienced
through restrictions or inability to undertake a range of activities as well as increased
reliance on others to undertake activities.
The need for support can result in a high level of reliance and involvement by family
members in the lives of the vision impaired. This is noted as having impacts on both
family members as well as the vision impaired person themselves. Family members can
feel particularly bound or responsible for vision impaired family members, while the vision
impaired person may struggle to develop independently. The vision impaired individual
may recognise the additional costs borne by family members because of their vision
impairment. This may in turn, lead them to try and minimise their call on others, a
response which can add to the difficulties and stressors already faced.
Young people identify a range of ways in which they can struggle to achieve
independence. They may be particularly reliant on their parents for transportation and may
be required to live at home for longer than they would if they were sighted.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 112
For parents of vision impaired children, the loss of independence can be experienced
through the increased dependence the vision impaired child typically has on their parents.
This can be experienced in many ways. Fewer opportunities for time out from the vision
impaired child is reported. There can be many reasons for this: the need to be constantly
aware of what the child is doing, particularly around potential physical dangers; the child
being less able to engage in more independent and group play; and that the child is less
likely to easily visit and play with other children.
The additional time and financial costs incurred because of the vision impaired child can
also result in less time or attention spent with other children in family. Parents may
inadvertently emphasise the achievements of the vision impaired child over siblings,
potentially adding to further sibling rivalry or resentfulness. Family activities may also be
restricted if certain activities are deemed inappropriate or particularly difficult for the vision
impaired child to engage in. Identified examples include going to the movies, tramping, or
visiting the zoo. Such family dynamics may in themselves lead to further costs to the
family, for example, behavioural problems with the sighted siblings or even relationship
breakdown within the family.
10.1.2
Difficulties Achieving Social Integration
Participants commonly report that blindness or vision-impairment can create many
difficulties in social interactions and developing social networks, particularly with sighted
people (refer also: Mott & Riggs, 1992; Advisory Council for the Community Welfare of
Disabled Persons, 1989; Whitbourne, 1985). Difficulties may be experienced in identifying
what social opportunities exist, where they are and how they would be accessed. There
may be further need to identify how suitable the group or activity will be for a vision
impaired person.
This can include the extent to which there is willingness to
accommodate the specific needs of blind or vision impaired participants. Making initial
contact with the group or activity may be difficult; particularly when the vision impaired
person is cognisant of the specific needs and requirements they will bring to the group.
Furthermore, substantial planning can be required to participate, including transport
arrangements and potentially significant transport costs.
It is noted that the ability to fit in and participate in a range of social activities is often
highly reliant on initiating and maintaining visual contact with others. The inability to
initiate visual contact is commonly noted as a barrier to forming relationships (refer also:
Newbold, 1987). Initiating and maintaining social interactions in unfamiliar or crowded
social settings such as parties, nightclubs or other social gatherings, can be particularly
difficult. Comments from a number of participants illustrate these difficulties further:
"You are like a wall flower… You just sit there." (Female Older adult)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 113
"It's difficult to circulate like everybody else does in a gathering.
You can't look across a room and spy somebody and head over
there and meet them ...If we're at a function it definitely has an
impact on how effective you are with networking, or even just
social contact." (Employed Female)
"… you [have to] sit back and wait for them to come to you, and they don't
always. You can be sitting and nobody is talking to you at all." (Female
Older Adult)
The difficulties encountered in social situations may result in blind or vision impaired
people ‘sticking’ together in social situations or electing to socialise primarily with other
vision impaired people. Social difficulties may result in a loss of confidence and possibly a
withdrawal from, or avoidance of certain social situations, for example, loud bars, clubs
and other settings where there may be a lot of people. One male participant comments:
“…All my mates were going clubbing and stuff. You would go as a group,
but a lot of them would grab a drink and go off and mingle… I would be
stuck on my stool having a beer. Someone would come back every ten
minutes and [ask], 'how are you doing, do you want another beer?' If I
was just stuck on a stool listening to music I can do that at home…I have
gone to this place to meet people and have a laugh, and I am bored out of
my wits." (Working Aged Male)
Social interaction may get particularly difficult for older adults due to the physical and
emotional effort that can be involved in maintaining social connections with limited or no
sight.
The partners of vision impaired people may also incur costs as a result of the social
constraints experienced by their partners. For example, one participant reports never
going to the movies because his partner is not inclined to do so.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 114
11. MEDICAL, ASSESSMENT AND SERVICE PROVISION
COSTS
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%)
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 115
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 GP’s ($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 drivers of taxis or public transport20, 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%).
Likely reflecting the travel distances required, the need for additional assistance to consult
GPs, ophthalmologists, optometrists, podiatrists and chiropodists is greatest for those
20
Accounted for elsewhere in the survey see Transport and Mobility.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 116
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 (low estimate). This includes costs of
any consultation fees or payments to helpers by the individual or their family. Under the
medium epidemiology estimates (ophthalmologist scenario) the total financial costs are
$6.9m in 2004. According to the high epidemiology estimates (NZ Disability Survey
scenario) the total cost is $14.7m.
Table 43: Annual Medical & Health Consultation Financial Costs, to the Individual and
Society (Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
503
0
503
Vision impaired
1,429
0
1,429
Total Blind and VI
1,932
0
1,923
Blind
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
(less than 18 years) account for the least financial costs associated with medical and
health consultations ($15,000).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 117
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 (low estimate). This includes costs for time spent
by the family and / or society in providing help or support to attend medical consultations.
Under the medium epidemiology estimates (ophthalmologist scenario) the total time costs
are $115,000 in 2004. According to the high epidemiology estimates (Disability Survey
scenario) the total cost is $229,000.
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 (Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
7
6
13
Vision impaired
12
1
13
Total Blind and VI
18
7
26
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.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 118
Total Medication & Drugs Financial Costs
Total annual financial costs associated with medication and drugs are estimated at
$817,000 for the Foundation membership (low estimate). This includes costs incurred by
individuals and families in purchasing prescription, non prescription and herbal medication
taken for their vision impairment.
Under the medium epidemiology estimates
(ophthalmologist scenario) the total financial costs are $2.7m in 2004. According to the
high epidemiology estimates (Disability Survey scenario) the total cost is $6.1m.
Table 45: Annual Medication and Drugs Financial Costs, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Visual status
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
141
-
141
Vision impaired
676
-
676
Total Blind and VI
817
-
817
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 injuries 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
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 119
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 onto 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 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%) resultant consultations from medical treatments results 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 simplistic framework
that does not 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
public and private sectors, as well as independent optometrists. Collecting records from
individual operators would be an exhaustive process and neither the New Zealand
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 120
Association of Optometrists nor the New Zealand Ophthalmologists Association collects
data from their members about clients.
The Ministry of Health collects information on contracted volumes of patient services from
the District Health Boards on an annual basis for budgeting requirements. 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
related accident that doesn’t cause vision impairment) could visit an ophthalmology
department for treatment. Therefore, these figures over estimate 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 2003/04 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 2003/04.
Auckland DHB provides two and a half times more inpatient services than expected based
on its share of total New Zealand population.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 121
Table 46: Ministry of Health Contracted Ophthalmology Services by DHB(2003/04 Financial Year)
District Health
Board
Inpatient
Services
First
Attendance
Northland
481
Waitemata
-
1,335
Subsequent
Attendance
2,800
-
-
Minor Eye
Procedures
Eye Laser
Procedures
Additional
Consults
TOTAL
-
224
-
-
-
-
4,840
Auckland
2,353
14,184
25,764
4,485
1,297
-
48,083
Counties
Manukau
456
2,807
7,540
122
664
-
11,589
Waikato
763
4,430
10,815
400
450
-
16,858
Lakes
319
770
3,000
-
-
158
4,247
Bay of Plenty
308
700
3,216
290
120
-
4,634
Tairawhiti
108
515
1,100
-
116
35
1,874
Hawkes Bay
332
725
1,761
-
200
-
3,018
Taranaki
303
1,020
3,000
-
100
-
4,423
MidCentral
276
1,672
4,500
110
-
280
6,838
Whanganui
186
1,005
1,860
350
96
-
3,497
Capital and Coast
889
4,663
7,713
250
900
-
14,415
-
-
-
-
-
-
-
-
1,286
692
150
-
7,482
-
-
-
-
Hutt
-
-
Wairarapa
70
420
796
Nelson
Marlborough
340
1,300
5,000
West Coast
-
Canterbury
900
5,150
12,909
420
205
-
19,584
South Canterbury
127
650
2,140
100
200
-
3,217
-
-
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 122
Otago
511
3,624
12,356
445
300
-
17,236
Southland
128
850
2,150
-
200
-
3,328
8,849
45,820
108,420
TOTAL
7,664
5,222
473
176,448
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 123
11.3 Ministry of Health Costs for DHB Ophthalmology Services
Alongside the contracted volume of clients by DHB, the Ministry of Health provided
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.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 124
Table 47: Ministry of Health Budgeted Value of Ophthalmology Services and Treatment (2003/04 Financial Year)
District Health
Board
Inpatient
Services
First
Attendance
Subsequent
Visits
Minor Eye
Procedures
Eye Laser
Procedures
Additional
Consults
Total
Northland
$ 1,312,675
$
157,917
$
$
-
$
$
-
$ 1,833,628
Waitemata
$
$
-
$
$
-
$
$
-
$
Auckland
$ 6,419,592
$ 1,677,797
$
2,773,072
$
579,471
$
357,133
$
-
$11,807,063
Counties
Manukau
$ 1,244,219
$
332,040
$
811,530
$
15,233
$
182,812
$
-
$ 2,585,834
Waikato
$ 2,081,884
$
524,025
$
1,164,018
$
51,944
$
123,894
$
-
$ 3,945,765
Lakes
$
866,885
$
90,853
$
322,094
$
$
158
$ 1,323,225
Bay of Plenty
$
833,588
$
82,130
$
343,347
$
Tairawhiti
$
300,115
$
62,013
$
120,524
$
Hawkes Bay
$
878,627
$
83,178
$
183,566
Taranaki
$
882,851
$
120,656
$
Mid Central
$
752,629
$
197,775
Wanganui
$
505,555
$
Capital & Coast
$ 2,425,929
Hutt
$
Wairarapa
$
Nelson
Marlborough
$
West Coast
$
Canterbury
South
Canterbury
-
301,364
-
-
-
-
-
$
32,771
$
-
$ 1,329,289
-
$
37,993
$
35
$
$
-
$
53,408
$
-
$ 1,198,778
322,890
$
-
$
27,532
$
-
$ 1,353,929
$
484,351
$
14,284
$
$
280
$ 1,523,801
118,620
$
199,764
$
45,346
$
26,372
$
-
$
$
551,626
$
830,264
$
32,468
$
247,816
$
-
$ 4,088,103
$
-
$
211,497
$
51,156
$
927,707
$
153,772
$
$
-
$
$ 2,455,695
$
609,194
$
1,389,396
$
54,541
$
$
$
76,889
$
230,328
$
12,986
$
-
346,526
-
37,453
$
61,672
-
530,455
895,658
$
-
$
-
$
-
$
-
88,221
$
-
$
-
$
-
$
350,873
538,168
$
$
-
$ 1,750,807
$
-
$
56,441
$
-
$ 4,565,266
55,064
$
-
$
-
$
89,861
-
$
$
41,298
-
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 125
721,793
Otago
$ 1,393,552
$
428,683
$
1,329,876
$
Southland
$
$
101,382
$
233,340
$
TOTAL
$ 24,229,999
$ 11,666,112
$
390,473
$ 5,419,705
57,788
991,375
$
82,596
$
-
$ 3,292,495
$
55,520
$
-
$
$
1,442,323
$
473
780,715
$43,877,477
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 126
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)
$10.0
$9.0
$8.0
Expenditure ($m)
$7.0
$6.0
$5.0
$4.0
$3.0
$2.0
$1.0
$1999
2000
2001
2002
2003
Financial Year
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.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 127
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 2002 and 8,700 clients receiving support for sensory
disabilities in 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 2002 to $103m
in 2003 (13% increase). Community Residential Care for Clients with Intellectual
Disability accounted for approximately 26% of total funding in 2003 ($27m). Home
Support (Mainly Household Management and Personal Care) accounted for 24% of total
funding in 2003 ($24.8m).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 128
Table 48: Number of Clients Receiving Disability Support Services and Funding for Each
Service Type (2002 and 2003 Financial Year)
Disability Support Service
2001-2002
2002-2003
Clients
Claims excl
GST
Clients
Claims excl
GST
Ageing in Place Service
-
-
6
$29,680
Aged
Residential
Care
Services - Dementia Care for
Clients with Aged Disabilities
136
$1,702,395
154
$2,166,640
Aged
Residential
Care
Services - Hospital level care
for
Clients
with
Aged
Disabilities
813
$18,532,081
874
$21,307,798
Aged
Residential
Care
Services - Psychogeriatric
Hospital level care for Aged
Clients
26
$811,353
28
$1,061,275
Aged
Residential
Care
Services - Resthome level care
for Aged Clients
812
$14,851,954
863
$17,354,346
Aged
Residential
Care
Services - Hospital level care
for clients with Non Aged
Disabilities
2
$155,755
7
$74,379
Aged
Residential
Care
Services - Resthome level care
for Non Aged Clients
11
$292,479
15
$276,796
Aged
Residential
Care
Services for Non Aged Clients
4
$116,796
10
$102,330
Carer Support
909
$3,517,974
924
$3,517,760
Day Programme for clients with
Intellectual Disabilities
59
$521,446
62
$491,091
Day Care
Dementia
2
$3,974
4
$6,934
for
clients
with
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.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 129
Summary Table 49: Annual Costs of Transport & Mobility, to the Individual and Society
(Low Estimate, RNZFB Membership scenario)
Cost Activity
Cost to Individual
($000’s)
Cost to Society
($000’s)
Total Cost
($000’s)
Blind
Vision
Impaired
Blind
Vision
Impaired
Blind
Vision
Impaired
Medical
ConsultationsFinancial Costs
503
1,429
0
0
503
1,429
Medical
ConsultationsTime Costs
7
12
6
1
13
13
Medication
&
Financial Costs
141
676
0
0
141
676
651
2,117
6
1
657
2,118
Drugs-
Total ALL Costs
Total cost to groups
2,768
7
2,775
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 130
12. SUPPORT AND SERVICES NOT AVAILABLE
12.1 Support Not Accessible
Survey respondents were asked if there was any equipment, service or other resources
(‘support’) that they required but were unable to get, for whatever reason.
Eighty percent of respondents report not requiring any additional ‘support’ to that which
they were already receiving. However, we have concerns that this may potentially
understate need for a number of reasons:
i)
Firstly, this issue was assessed through a single open ended question
(covering equipment, support and services) at the end of the questionnaire,
where respondents were becoming fatigued after almost one hour of
discussion in many cases.
ii)
For many respondents, the preceding questions emphasised all the help and
assistance they already receive and may have made it more difficult to
specify additional requirements.
iii)
Since, the question was unprompted it is only likely to capture key concerns
of respondents. A prompted question which referred in each area to what
respondents currently have or receive, what they'd prefer to have or receive,
the barriers to achieving this and the strength of need or preference would
have been a far superior approach. However, the survey length precluded
this approach.
We note that more detailed questioning of this nature in relation to transport revealed
more significant levels of desire to make more journeys. It is worth considering more
comprehensive research into this area in the future to provide a more definite picture.
Most ‘support’ identified as being inaccessible by 1% or more all respondents comprises
equipments items. Equipment items identified include: enlarged screen/scanner/CCTV
(4% of all respondents); talking equipment (4%); special glasses or contact lens (2%);
computer software (2%); improved lighting (2%); computers (1%); magnifying equipment
(1%) and mobility scooter (1%).
Being too expensive or unaffordable is clearly the most common reason why required
‘support’ is considered inaccessible. Over two thirds (68%) of respondents identifying
‘support’ as being inaccessible cite affordability as the reason for this. Financial barriers
are particularly common for provincial respondents, with 89% of these respondents
identifying unmet ‘support’ needs, citing cost as a reason.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 131
Other financial based reasons identified include uncertainty as to if and where financial
assistance is available (4%) and because the ‘support’ required is ineligible for financial
assistance (3%).
Of the two equipment items most commonly identified as being inaccessible (enlarged
screen/scanner/CCTV and talking appliances), the lack of affordability accounts for almost
all the reasons given for inaccessibility (94% and 92% respectively).
While acknowledging the limitations of this question, overall findings are similar to those
derived from the 2001 New Zealand Disability Survey. In this survey, 21% of blind and
vision impaired adults in households reported having an unmet need for some type of
equipment or service. Cost barriers were again identified as the most common reason for
this need (Statistics NZ, 2003).
Limitations, uncertainty or difficulties in the provision of ‘support’ are also common
reasons for inaccessibility. This includes: uncertainty whether the required ‘support’ exists
(29%); the unavailability of required ‘support’ in the local area (12%); transport or travel
distance barriers (8%); the inappropriateness or dislike of ‘support’ that is provided (6%);
and, uncertainty about how to access required support (1%).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 132
13. ECONOMIC COSTS OF OTHER SERVICE PROVISION
13.1 RNZFB Services
The RNZFB is the only major provider of blindness services in New Zealand (RNZFB
2002). These services are made possible only through the Foundation’s government
contracts, fundraising efforts and investment. This section provides a brief overview of the
costs of services to blind and vision impaired members.
The Foundation in its Annual Report 2002-2003 (RNZFB website) reports the following
costs and sources of income:
 Total expenditure on member services
$17,551,000
 Net income from Fundraising
$10,261,000
 Income from Government Funding
$5,121,000
13.1.1
Volunteer Services
The Foundation’s delivery of services to members benefits from significant contributions
from volunteers, reported by the Foundation to number more than 16,000 (RNZFB 20022003 Annual Report, RNZFB website). The value of the Foundation’s Volunteer services
was investigated further in the recent Value Added by Voluntary Agencies (VAVA)
research.
The VAVA research found that:
 the total estimated number of volunteer full-time equivalent jobs created by the
Foundation of the Blind is 823;
 input-voluntary-value-added by the RNZFB is estimated to be between $28.6
million and $42.6 million annually, with $15.7 million to $29.7 million being the
estimated contribution from its volunteers.
13.2 Postal Concession
Postal charges for mailing talking books, Braille books as well as mail between blind
consumer groups and between blind persons and others are currently covered through a
contract between the Ministry of Social Development and NZ Post. Similar concessions
exist for the blind in the United Kingdom, Australia, Canada and the United States (ABC
website 2003). The concession provides recognition of the fact that blindness severely
limits a person’s ability to access written information (ABC website 2003). Prior to 1987,
the provision of the postal concession was a legislated concession. Currently, however,
the contract between MSD and NZ Post secures the concession and is reviewed annually.
For 2003-2004, the postal concession is valued at $690,000 (excluding GST).
The RNZFB’s Braille and Talking book library is the largest user of the postal concession,
with the mailing of Braille and Talking books estimated to account for approximately 87%
of the available fund (RNZFB Personal Communication, 4th August, 2004).
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 133
13.3 Other Services
There are many other services provided that may support or provide assistance to blind
and vision impaired persons on an everyday basis. These services range from local
government provisions through to the work of volunteers at the Levin Radio reading
service. Two examples of other services are discussed below.
Recreational Services
Some city councils provide a concession pass for leisure activities for people with
disabilities or for those on benefits. Christchurch City Council and The Community Trust
support the Kiwiable programme, an initiative designed to promote an inclusive community
that offers information, to persons with disabilities, on accessible sport, leisure and
recreation activities. Kiwiable encourages and supports people with disabilities to become
more active and also provides disability awareness training. The programme also
administers a Leisure card, designed to reduce the cost of recreation and leisure for
persons with disabilities. The card provides discounts on a variety of recreation and
leisure services, museums, movies, gyms and sporting centres. To be eligible for this
card individuals must be receiving the Invalids Benefit, Sickness Benefit, long term ACC
and with more specific criteria for those under 16 years.
Similar programmes are offered by Wellington and Manawatu City Councils. The
Manawatu ‘Recreation Ticket’ provides discounts on leisure and learning services for a
wider variety benefit groups and is not as specifically targeted to persons with disabilities
as Christchurch’s Kiwiable.
Information Services
The Radio Reading Service is a not for profit radio station which operates from Levin and
broadcasts the mid-central North Island. The station provides comprehensive and timely
reading of everyday printed literature (news and information) and is currently in the
process of expanding its reach. Similar services operate in the United States, Canada
and Australia. New Zealand’s Radio Reading service has been up and running since
1987 and currently delivers a total air time of 7620 minutes per week. The station is run
by volunteers and receives some funding from NZ on Air (in 2003 this was $90 000).
While this service may be of particular use to blind and vision impaired persons, other
print disabled New Zealanders such as the aged, dyslexic and physically impaired are
also seen as benefiting from this service.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 134
14. COST SUMMARY TABLES
The following tables summarise the cost estimates derived from the Costs of Blindness
survey of Foundation members expanded to the three population scenarios.
These are annualised costs and show the split between financial and time costs and the
allocation of cost burden between the individual (including their families) and society.
Note, that other societal costs such as Total Mobility, medical costs and costs of providing
benefits are reviewed in separate sections of the report.
Education costs are omitted as figures for the total blind and vision impaired populations in
education have not been able to be accessed by the research team. It is believed that
such information is able to be provided by the Tertiary Education Commission but was
unable to be provided for use in this research. In place of this a population estimate of
blind and vision impaired students totalling 850 (primary through to tertiary) has been
generated from information provided by the VEA and Disability Support Services at the
University of Auckland. This figure is in no way linked to the low (RNZFB), medium
(Opthamologists) or high (NZ Disability Survey) population estimates, thus education
costs are not presented here. Please see Section 6 for discussion of education costs.
This is an area which would require further investigation (please see separate document:
‘Data Collection Issues Encountered During the RNZFB Costs of Blindness Research’).
These tables (Tables 50, 51 and 52) do not include data collected from other secondary sources
such as RNZFB costs, government and council costs (in terms of subsidies or other costs) outside
what was reported by respondents in the Costs of Blindness survey. These have not been
included because of the lack of information in terms of either detail or consistency (please see
separate document: ‘Data Collection Issues Encountered During the Costs of Blindness
Research’). As such, discussions of identified and accessible secondary source information on
societal costs are addressed throughout this report. No attempt to collate or integrate this
secondary source data with the information derived from the Costs of Blindness Survey has been
made due to issues as above.
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 135
Total Cost Table 50: Total Financial Costs of Blindness, By Cost area activity,
Individual and Society according to Low, Medium and High Population Estimates
FINANCIAL COSTS
Activity
Domestic tasks (excl
Low Estimate
Medium Estimate
High Estimate
(RNZFB membership)
(Ophthalmologists)
(NZ Disability Survey)
Cost to
Cost to
Total Cost
Cost to
Cost to
Total
Cost to
Cost to
Total Cost
Individual
Society
($000’s)
Individual
Society
Cost
Individual
Society
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
4,525
8,614
13,139
15,607
28,745
44,352
29,523
48,869
78,392
102
1,833
1,935
260
5,866
6,126
458
11,898
12,357
1,705
1,619
3,324
6,656
7,297
13,953
14,202
14,956
29,158
64
598
662
246
2,622
2,868
488
4,706
5,194
Equipment - braille
515
535
1,050
1,117
4,928
6,045
2,516
4,397
6,912
Equipment - other
227
74
301
832
288
1,121
1,759
560
2,319
Equipment training
41
0
41
107
0
107
208
0
208
392
97
489
1,534
669
2,202
3,219
1,309
4,529
4,640
0
4,640
21,381
0
21,381
39,555
0
Housing
300
6
306
957
16
973
2,216
30
Recreation
325
3,678
4,003
935
20,564
21,499
1,931
36,459
498
0
498
1,876
0
1,876
3,823
0
179.5
496.9
676.4
244
5,021
5,265
225
shopping)
Shopping
Misc. Equipment cost
Equipment - computer
Equipment repair and
maintenance
Travel (excl work travel)
Education*
Travel to work
Employment Related
3,823
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 136
Travel
Work modifications
Medical
6
4
10
9
12
21
11
23
34
1,932
0
1,932
6,912
0
6,912
14,721
0
14,721
816.9
0.0
816.9
2,687
0
2,687
6,106
0
6,106
2.9
316.8
319.7
4
1,556
1,560
4
3,600
3,603
16,273
17,871
34,144
61,364
77,583
138,947
120,966
139,028
259,994
treatment/consultations
Medication
Voluntary work
TOTAL ALL
ACTIVITIES
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 137
Total Cost Table 51: Total Time Costs of Blindness, By Cost area activity,
Individual and Society according to Low, Medium and High Population Estimates
TIME COSTS
Activity
Domestic
tasks
(excl
Low Estimate
Medium Estimate
High Estimate
(RNZFB Membership)
(Ophthalmologists)
(NZ Disability Survey)
Cost to
Cost to
Total
Cost to
Cost to
Total
Cost to
Cost to
Total
Individual
Society
Cost
Individual
Society
Cost
Individual
Society
Cost
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
19,510
0
19,510
77,841
0
77,841
168,313
0
168,313
5,310
0
5,310
20,304
0
20,304
44,564
0
44,564
Misc. Equipment cost
0
0
0
0
0
0
0
0
0
Equipment - computer
0
0
0
0
0
0
0
0
0
Equipment - Braille
0
0
0
0
0
0
0
0
0
Equipment - other
0
0
0
0
0
0
0
0
0
211
155
365
516
1,205
1,721
873
1,512
0
0
0
0
0
0
0
0
8,942
4,111
13,053
42,739
21,027
63,767
86,851
46,015
0
14
14
0
76
76
0
179
4,442
0
4,442
15,843
0
15,843
35,419
0
190
46
236
858
203
1,062
1,861
462
0
5,022
5,022
0
37,813
37,813
0
93,846
shopping)
Shopping
Equipment training
Equipment
repair
and
maintenance
Travel (excl work travel)
Housing
Recreation
Education*
Travel to work
Employment
Related
2,322
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 138
Travel
Work modifications
59
421
480
80
3,857
3,938
74
9,469
9,543
Medical
18
7
26
78
37
116
170
57
227
0
0
0
0
0
0
0
0
0
5,948
0
5,948
29,935
0
29,935
66,727
0
66,727
44,629
9,775
54,404
188,196
64,219
252,415
404,852
151,540
556,392
treatment/consultations
Medication
Voluntary work
TOTAL ALL ACTIVITIES
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 139
Total Cost Table 52: Total Time Costs of Blindness, By Cost area activity,
Individual and Society according to Low, Medium and High Population Estimates
TOTAL COSTS
Low Estimate
(both Financial and Time
Medium Estimate (Ophthalmologists)
(RNZFB Membership)
High Estimate
(NZ Disability Survey)
Costs)
Activity
Domestic tasks (excl shopping)
Cost to
Cost to
Total Cost
Cost to
Cost to
Total
Cost to
Cost to
Total
Individual
Society
($000’s)
Individual
Society
Cost
Individual
Society
Cost
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
($000’s)
24,035
8,614
32,649
93,448
28,745
122,193
197,837
48,869
246,706
Shopping
5,412
1,833
7,245
20,565
5,866
26,431
45,022
11,898
56,920
Misc. Equipment cost
1,705
1,619
3,324
6,656
7,297
13,953
14,202
14,956
29,158
64
598
662
246
2,622
2,868
488
4,706
5,194
Equipment - braille
515
535
1,050
1,117
4,928
6,045
2,516
4,397
6,913
Equipment - other
227
74
301
832
288
1,120
1,759
560
2,319
Equipment training
251
155
406
623
1,205
1,828
1,081
1,512
2,593
392
97
489
1,534
669
2,203
3,219
1,309
4,528
13,583
4,111
17,694
64,120
21,027
85,147
126,406
46,015
172,421
300
20
320
957
92
1,049
2,216
209
2,425
4,767
3,678
8,445
16,778
20,564
37,342
37,350
36,459
73,809
Travel to work
688
46
734
2,734
203
2,937
5,684
462
6,146
Employment Related Travel
179
5,519
5,698
244
42,833
43,077
225
106,069
106,294
Equipment - computer
Equipment
repair
and
maintenance
Travel (excl. work travel)
Housing
Recreation
Education*
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 140
Work modifications
Medical
65
425
490
90
3,869
3,959
85
9,492
9,577
1,950
7
1,957
6,990
37
7,027
14,890
57
14,947
817
0
817
2,687
0
2,687
6,106
0
6,106
5,951
317
6,268
29,939
1,556
31,495
66,731
3,600
70,331
60,901
27,648
88,549
249,560
141,801
391,361
525,817
290,570
816,387
treatment/consultations
Medication
Voluntary work
TOTAL ALL ACTIVITIES
Royal New Zealand Foundation of the Blind
The Costs of Blindness in New Zealand Page 141
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The Costs of Blindness in New Zealand Page 145