Table 1: Country Information (Source Wikipedia)
|Country Name||New Zealand|
|Population||4,802,973 (estimated 2019)|
|Languages||English, Maori, NZ Sign Language|
Estimated population: 4,802,973. Of these, an estimated (2017) 734,200 identify themselves as indigenous Maori or consider themselves to be culturally affiliated to Maori. (Population | Stats Nz, n.d.) Net migration (Oct 2017): 70,694.
New Zealand lies about 1,600 km from both Australia and Polynesia. It has three main islands: the North and South Islands, with Stewart Island, lying due south of the South Island. New Zealand is the visible part of a large submerged super-continent. Today, the remains of this supercontinent form an archipelago with over 700 smaller islands, many of them uninhabited. New Zealand sits on the boundary of the Indo-Australian and Pacific tectonic plates, and frequently experiences earthquakes. (Taonga, n.d.)
New Zealand is a predominantly urban country with 86.5 percent of the population living in an urban area. About 73.0 percent of the population live in the 17 main urban areas (population of 30,000 or more) and 53.8 percent live in the four largest cities: Auckland, Christchurch, Wellington, and Hamilton. Auckland is the largest city with a population of around 1.5 million. A little under a quarter of the population lives in the South Island (“Geography of New Zealand,” 2021).
The capital city is Wellington (population 496,000, around 10.6% of the population) (Living in Wellington, n.d.), and is where parliament and most government offices are.
New Zealand was originally populated by Maori peoples who arrived, it is thought, in the 13th century. Currently, (2013 census) 74% of the population identifies as European, 14.9% identifies as Maori, 11.8% as Asian, 7.4% as Pacific peoples, and 1.2% as Middle Eastern, Latin-American, and African (for 2018 census) (Home | Stats Nz, n.d.).
Official languages are English, Maori (since 1987), and NZ Sign Language (NZSL, since 2006). English is the main spoken language, with 96.1% of respondents in the 2013 census indicating that they spoke English. In the same census, 3.7% of respondents reported conversational fluency in Maori, and 20,235 people reported the ability to use NZSL. Many migrants are multi-lingual.
There is no state religion, but the principal religion is Christianity. Originally, Maori peoples were animistic, but many were converted to Christianity when missionaries arrived in the 19th century. Other religions, especially Hinduism, Islam and Buddhism have been growing in recent decades. Just over 40% of respondents (2013 census) have no religion.
The adult literacy rate is 99% with over half of the population aged 15-29 holding some sort of tertiary qualification.
New Zealand is a parliamentary democracy established in 1856.
For local governance purposes, New Zealand is divided into 16 regional councils. There are 20 District Health Boards (DHBs) in New Zealand (2018) which provide funding to Primary Health Organisations (PHOs).
Salaries in New Zealand
The average salary (all occupations) before tax in New Zealand is $51,500 (Household Income and Housing-Cost Statistics: Year Ended June 2018 | Stats NZ, n.d.).
The average salary for a clinical audiologist in New Zealand (2018) is around NZ$80,000. The range is from NZ$60- NZ$106k depending on role and experience. Some privately-owned clinics offer additional bonuses, profit-sharing, commission based on hearing aid sales, and other performance indicators. Private clinics tend to pay more than District Health Boards (Audiologist Salary in New Zealand | Payscale, n.d.).
Audiology is a relatively new discipline in New Zealand.
Post WW2, post office electronic technicians moved into audiology working with basic analogue body aids.
The first qualified New Zealand audiologists were trained in the UK in the 1960’s to work in educational/paediatric areas. In the 1970’s/80’s a few graduates completed PhD qualifications in the USA.
Dr Bill Keith led the National Audiology Centre in Auckland where graduates would be trained onsite but not receive a formal qualification.
In 1977 the NZ Ministry of Health paid an average of four graduates per year to attend the University of Melbourne in Australia to complete a post-graduate Degree in Audiology. In return the audiologists were bound to stay in public health employment for 3 years.
A 1984 report from the then Department of Health found there to be 34.4 full-time equivalent audiologists in total in New Zealand -giving a ratio of 92,300 people per audiologist. Unofficial data estimated there were 41 otolaryngologists in 1984, representing a ratio of 77,000 people per specialist. A 2015 estimate was of 52,443 people per otolaryngologist (Exeter et al., 2015)
Number of Audiologists and Audiometrists in New Zealand
First incorporated in 1976, the NZ Audiological Society (NZAS) became the professional society for audiologists and it has included audiometrists since 2012. The Society is self-regulating, and membership is voluntary.
The November 2018 list of the New Zealand Audiological Society records that there are 377 full audiologist members of the Society and 26 full audiometrist members. These are members who have sat OSCE-style examinations run by the NZAS and are deemed to have passed. Audiologists and audiometrists have different scopes of practice. Only audiologists are required to have a two-year masters-level qualification in audiology. Some audiometrists have bachelor’s degrees in audiology or other qualifications from other countries. Other categories of the NZAS (Nov 2018) are: 67 inactive full audiologist members; 59 provisional audiologists (yet to sit professional exams); 16 provisional audiometrists, and a handful of “honorary” members. Including student members, there are now over 600 members of the NZAS.
Master’s in Audiology (audiologists). There are two universities in New Zealand that offer a master’s level degree in audiology. In 1990, Auckland University (North Island) began a two-year master’s program in audiology (M.Aud) followed in 2005 by Canterbury University in Christchurch (South Island). Both now average around 15 new students per year.
For many years, audiometrists (known in other countries as hearing aid dispensers, audiology assistants, or hearing aid technicians), ran their own society (ANZAI) which still exists.
In 2010/11 the NZAS Executive Council, with encouragement from the Ministry of Health, ANZAI and the corporate lobbying group the NZ Hearing Industry Association, decided to work towards inclusion of this group within the NZAS. This allowed some audiometrists to access the government subsidy for hearing aids on their patients’ behalf and made audiometrists subject to the NZAS supervision, rules, and complaints process. Up until then, many audiometrists in New Zealand were trained in-clinic and on the job, but the NZAS had no jurisdiction over them. Many audiometrists in New Zealand now have degrees or training in audiology from overseas. Audiologists trained overseas who do not have a two-year master’s degree in audiology may apply to become an audiometrist member of the NZAS.
Schools for the Deaf
There were, until 2019, two main schools for the deaf in New Zealand that have now merged their administrative and management levels. These were:
Van Asch Deaf Education Centre, Christchurch (South Island). Founded in 1880, it was the oldest fully government-funded school for the Deaf in the world. It began as an oral education school, (punishments were administered for using sign language); but these days an integrated approach including New Zealand Sign Language (NZSL) is used. https://en.wikipedia.org/wiki/Van_Asch_College
Kelston Deaf Education Centre, Auckland, (North Island), residential school, was founded in 1958.
Both schools had a shared library catalogue with resources for deaf people and families.
These two schools merged in 2019 to become one national school, offering services to Deaf and Hard of Hearing (DHH) children throughout New Zealand. This combined school with two campuses was re-named Ko Taku Reo School https://www.kotakureo.school.nz/about-us/our-history
It is very difficult to find figures regarding hearing loss incidence and prevalence in New Zealand that have been derived from New-Zealand-based research. In December 2016, Deloitte published a report commissioned by the NZ National Foundation for the Deaf on the social and economic cost of hearing loss in New Zealand (The National Foundation for the Deaf, 2016).
This report estimates that over 880,000 people in New Zealand (18.9%) may have suffered from some form of hearing loss at the time of the report with the total cost of hearing loss reaching an estimated NZ$4.9 billion. The cost to the economy was estimated at $957.3million. These figures are extrapolated to the New Zealand situation from information collected in other countries (such as Scandinavia) and are not based on New Zealand data. However, this report is widely referred to by hearing industry groups and deaf support groups, as well as government bodies.
More recently, the NZ Hearing Industry Association, an industry lobbying group representing manufacturers and audiology corporates such as Amplifon and the retail arm of Sonova, have issued a report giving information underpinning sales-relevant information for hearing aids in New Zealand (New Zealand Hearing Industry Association, 2018)
While it is well-known that only a small proportion of people with hearing loss seek and obtain hearing aids, even in countries like the UK where they are free. The following figures of partially subsidised and fully funded aids (not the fitting fee) has been provided by the NZ Ministry of Health:
|Hearing Aid Subsidy||11,421.00||12,017.00||13,927.00||15,131.00||16,801.00|
|Hearing Aid Funding||5,761.00||5,834.00||5,860.00||6,178.00||4,251.00|
A two-year master’s degree in audiology (M.Aud) is offered at two universities: Auckland in the North Island, and Canterbury (Christchurch) in the South Island.
Their websites can be found at: https://www.fmhs.auckland.ac.nz/en/soph/about/our-departments/audiology.html and
The courses include clinical and research (thesis) components, as well as engineering, auditory neuroscience, anatomy, ear pathology, and paediatric and adult audiology. Practical components of the course are run at volunteering clinics in both the private and public sectors which have agreed to take students to observe clinical practice. In the summer at the end of year one of the course (December to February), students take up placements with volunteering clinics that offer places for a total of 8-9 weeks. This summer practicum may be spread across two clinics with a mixture public and private experience for students when possible. During this time, the student will also do a hearing aid project based on a patient they have observed with an obtained consent from (Audiology – the University of Auckland, n.d.; (UC Speech and Hearing Clinic | Communication Disorders | College of Science | University of Canterbury, n.d.).
Generally, audiological treatment at a public facility (audiology department at a hospital) requires a referral by a general practitioner (family practice doctor). Not all hospitals have audiology departments, and some hospitals struggle to recruit audiologists due to the pay differential between public and private clinics.
Audiological treatment at a private clinic does not require a referral, and potential patients may self-refer to any of the numerous private clinics around the country. Despite the tax-base being relatively small, the New Zealand government, via the Ministry of Health, grants subsidies and funding based on various criteria for hearing aids and some cochlear implants (but not for vestibular or other audiology treatment such as tinnitus management and counselling).
New Zealand has access to the latest hearing aid technology and support from the so-called “Big 6”: Sonova, William Demant, GN Resound, Signia, Widex, and Starkey. (Cook, 2016). Signia and Widex merged in March 2019 to become WS Audiology, but there is still separate support within NZ for these products (Sivantos and Widex Complete Merger, 2019).
Government Funding for Hearing Aids and Hearing Services: Public & Private
Funding and subsidies towards the cost of hearing aids are available in New Zealand to adult patients attending both public and private clinics.
The Ministry of Health provides free hearing aids and related services for children and young people (up to the age of 21 who are full-time students) via hospital audiology departments. Parents who wish to take their children to a private clinic for the same services will pay for the services to the private clinic, but the hearing aids will be covered.
Only Audiological Society (MNZAS) audiologists and some audiometrists who also belong to the society, can access Ministry of Health government subsidies and funding for hearing aids on behalf of their patients.
The Accident Compensation Corporation (ACC), incorporated in 1974, is a government-funded agency that provides tax-payer funding on a “no-fault” basis, for hearing loss deemed to be due to accident, medical misadventure, or occupational noise exposure (ACC – Home, n.d.). There is a minimum requirement of 6% hearing loss, using National Acoustic Laboratory population-based age percentage-reduction calculations (National Acoustic Laboratories –, n.d.). The ACC regulations are set by legislation, and periodically updated after consultation with a broad range of stakeholders.
Applicants must live permanently in New Zealand (residency or citizenship) and have suffered all or most of the hearing damage in New Zealand.
In the past, all hearing aid provision costs were covered for eligible people. However, since 2010, there have been several changes in the legislation. Hearing aid funding now comes in three bands (ranging from approximately NZ$3,000 to NZ$5,000 (incl GST for a pair of aids), which includes a fitting fee for audiologists. Replacement batteries and two annual appointments are paid for by the ACC, as well as repairs up to a capped amount within every 2-year period. Funding is available no more than once every 6 years for eligible claimants.
Funding is accessed by patients through MNZAS audiologists, (not audiometrists, although this may change). Audiologists must carry out a full diagnostic test (as per NZAS requirements) on candidates for ACC funding in an ISO 8253-1:2010 clause 11 compliant sound-treated environment (as per ACC rules). Audiologists must also declare on an ACC form that they do not work for a hearing aid manufacturer or associated entity (although companies that are “vertically-integrated” avoid this rule).
Determination of eligibility and the further apportionment of the percentage hearing loss due to ACC’s criteria is made by Ear-Nose-and-Throat specialists, but aids are fitted by audiologists/clinics chosen by the individual ACC claimant. Funding granted can be used towards any level of technology, make, and model of hearing aids. ACC encourages patients to obtain second opinion quotes for their aids from another clinic if unhappy with their first pricing option.
The Ministry of Health subsidy scheme. This is managed by Enable on behalf of the Ministry. This currently stands at NZ$511.11 incl GST per ear, not more than once every 6 years for residents or citizens of New Zealand aged 16 or older. This subsidy is applied to the wholesale cost of the aid, not to the fitting fee, and is available to patients who go through either public or private clinics (Health and Disability Support Resources » Enable New Zealand, n.d.).
The Ministry of Health Funding scheme. This is also managed by Enable. Eligibility requirements exist, e.g. hearing loss since childhood, dual disability including hearing loss (e.g. Deaf/Blind), or other criteria. Wholesale costs of aids are paid directly to manufacturers by the government up to capped amount, but a fitting fee of varying amounts, decided by each clinic or clinic group, is paid by the patient directly to the audiologist.
Veterans’ Affairs Funding. Funding includes a capped amount for eligible New Zealand military veterans for hearing aids, and other services, such as repairs. A battery allowance is added to eligible veterans’ pensions. Apply through an MNZAS audiologist for Veterans’ Affairs Funding (Home | Veterans’ Affairs, n.d.)
Work and Income NZ (WINZ) loans for hearing aids.
These are for people who may be receiving a government benefit, such as a pension or a disability allowance and are means-tested. The loaned amount is gradually paid back by being deducted at source from the benefit. Apply through an MNZAS audiologist registered to do WINZ loans.
Public (Hospital-based Audiology)
About 20 hospitals in New Zealand have audiology departments. Audiologists working in public health tend to focus on paediatric work, for which a specialist NZAS “Paediatric Certificate” is required. Auditory brain-stem responses, and otoacoustic emissions are more likely to be tested and measured in a hospital rather than a private setting. Hospital audiology services are funded by the taxpayer and therefore, are often free to the public and hearing aids at a reduced cost.
However, due to funding constraints, there are fewer adult services able to be offered and often eligibility requirements for adults are generally linked to people on lower incomes. Hearing aids obtained through the hospital may still require some co-payment from the patient.
Hearing aids purchased through a hospital will generally cost a person less than through a private practice for similar technology levels. This is because the staff salaries and departmental general costs are met by the New Zealand taxpayers However, follow-up appointments are likely to be fewer at a hospital due to staffing constraints.
Eligibility Criteria for Hearing Tests at Hospitals (taxpayer funded)
Hearing tests are available for:
People outside of these criteria will need to be assessed at a private clinic (Audiology, n.d.)
Hearing Assessments for Children at Hospitals (taxpayer funded)
Hearing assessments may include:
Eligibility Criteria for Hearing Aids through a DHB Hospital
There is no significant wait list for children’s hearing aids because hearing is essential to early speech, language, and social development.
To be eligible for free or reduced-price hearing aids via the public service, adults must hold a current Community Services Card and either:
There may be a waiting list for adults, and this can exceed two years at some hospitals unless there are significant safety concerns.
Referrals are accepted from:
Audiologists may ask patients who meet the above requirements to request that their doctor refer them to hospital audiology departments. Audiologists are not currently on the published list of people who can refer directly to hospitals.
Other Publicly Funded Services in NZ
Cochlear Implants in New Zealand
Implants are available via both public (the majority) and privately funded routes. There is limited public funding, and adult (but not child) waiting lists are currently at around 2-3 or even 4 years.
The NZ Ministry of Health funds cochlear implant services for people who meet the following criteria:
The funded (public) service includes:
For children, the funded service also covers the cost of any repairs or spare parts for their speech processors. Adults (aged 19 years or older) don’t have these costs covered.
Only one implant is funded per adult. The Ministry does not fund follow-up services for adults (aged 19 or older) who received their implant outside of New Zealand or who paid for their implant privately.
Due to the long waiting lists, adults may choose to apply for one-off government grants to pay for a single cochlear implant; however, implants paid for using these grants are treated in the same way as a privately-paid implant; repairs and upgrades are not covered by the government. This has apparently made some potential implantees hesitate to take up the offer (Cochlear Implants, n.d.).
Children May Have Two Implants Funded
Children under 19 years of age with severe to profound hearing loss in both ears and are newly assessed as needing a cochlear implant can receive Ministry funding for one ear or both ears, whichever is clinically recommended by their specialist. Follow up services are funded for both ears.
Programs for Detecting and Tracking Hearing Loss in Babies and Children (publicly funded)
Universal Newborn Hearing Screening (UNHS)
First rolled out in 2010, following regional pilot schemes, this free nationwide screening program aims to have every child screened by the age of three months (New Zealand Deafness Notification Database | National Screening Unit, n.d.).
Vision Hearing Screening for pre-schoolers is part of the B4 School, free, country-wide school check for health and well-being. Vision and Hearing Technicians give preschool and school hearing screening tests to four-year olds, before they start school at age 5. If a child fails the test, they are referred on to hospital audiology (Vision and Hearing Screening | RPH, n.d.).
NZ deafness notification database:
This has been running since 1982, first via the National Audiology Centre/Auckland DHB, and now as a separate entity. The details of children who are found to have permanent hearing loss (greater than a slight loss, and not a conductive loss), with the written consent of parents, are entered online into this database by the audiologists who diagnose the hearing loss. Since the rollout of Universal Newborn Hearing Screening, consent forms are signed at the time of the screening for later deafness notification should it be necessary (New Zealand Deafness Notification Database | National Screening Unit, n.d.). Comprehensive reports are published each year and are available here: https://www.audiology.org.nz/deafness-notification-database.aspx
Ear hygiene mobile free services for children aged 0-18:
In many areas, there is a free ear mobile service run by the local DHB which may visit more remote areas with a registered nurse who is trained as an ear nurse specialist. Services are ear checks for discharging ears, education, and wax and foreign object removal (Porirua Children’s Ear van | Rph, n.d.)
Private Audiology Clinics
There are several different types of private audiology clinics throughout the country. Of these, the majority offer diagnostic and screening hearing testing and hearing aid fittings and related rehabilitation services. A few also specialise in tinnitus management or auditory processing disorders. There are very few clinics specialising in vestibular disorders, and this area is also served by vestibular physiotherapists. All clinics with MNZAS audiologists may access government funding for eligible patients who need hearing aids, on the understanding that work carried out by a non-MNZAS clinician is supervised or checked by an NZAS member. Anyone may self-refer to a private clinic, although referrals also come from GPs and specialists.
Children may also access hearing aids through private clinics if their parents choose this route. The privately accessed hearing aids will be fully funded by the Ministry of Health through their Enable funding body, but there will usually be a fitting fee which varies from private clinic to private clinic.
Private clinics fall into 5 main categories:
Many private clinics also have so-called “satellite clinics” which may only operate a few days per month and are in less-populated areas.
Anyone can attend a private audiology clinic – no referral is required from an ear-nose-and-throat specialist, general practitioner, or other medical specialist.
Most private clinics in New Zealand offer a “bundled” pricing model for hearing aids, fittings, and follow-up appointments. That is, while costs for services such as hearing tests are individually priced, costs for hearing aids are bundled with the cost of fitting and adjusting the aids over a trial period as well as counselling. Trial periods can range from 2-8 weeks. Aids can be returned for a refund during this trial period. Some clinics will then charge for the failed fitting, and some will not.
A small number of clinicians work in conjunction with ear-nose-and-throat specialists and may have shared ownership or shareholdings.
Other independent clinics may operate in a franchise-like arrangement, where one owner of a company has shares ranging from 25% to 75% in several other clinics, each operated by a semi-autonomous clinician, who also draws a salary.
Some independent clinic owners belong to Independent Audiologists NZ (IANZ). This is affiliated with Independent Audiologists Australia and has links with ADA. IANZ supports and promotes independent clinics owned by audiologists and supports the registration of audiology as applies to other healthcare and allied workers but is not yet required for audiologists operating in New Zealand. IANZ members must be practicing audiologists and must own at least 51% of their practice (or, if in shared practice, a combined controlling share). They agree not to pay commission to their staff based on their hearing aid sales and so the audiologists are not incentivised to up or oversell products to patients. IANZ members also agree not to enter percentage sales contracts with manufacturers, so that they remain free to fit whichever aids are the most appropriate for any given patient. They have no financial links to manufacturers or overseas-owned companies. They pay tax in New Zealand.
Manufacturer-owned clinics of overseas parent companies tend to fit their own-brand hearing aids more than other brands. Currently in New Zealand, there are clinics owned by Sonova (Triton clinics: brand Phonak and Unitron), Sivantos (brand Signia, formerly Siemens), William Demant (Formerly “Hearing Life” clinics, now rebranded as “Audika”: brands, Oticon, Bernafon, and Sonic), and Widex (Bloom clinics: brand Widex). (Sivantos and Widex parent companies have merged). All of these brands are also available at independent clinics and public clinics, in addition to brand Starkey which currently does not have its own-brand clinics in New Zealand. Some manufacturer-owned clinics may not pay much, or any, tax in New Zealand, as they can make use of international tax vehicles such as transfer pricing. Some appear to post no or little profit in New Zealand. Amplifon NZ owns non-manufacturer clinic “Bay Audiology”, with global agreements with Phonak, GN Resound, and other manufacturers.
Some manufacturer and corporate-owned clinics have ties to “The Hearing Industry Association”, a lobbying group.
University clinics operate as for-profit businesses, but also are used for teaching and research purposes. Both university clinics are also involved in research. The University of Auckland audiology department is known for tinnitus research, with their clinic specialising in tinnitus assessment and treatment (Hearing and Tinnitus Clinic – The University of Auckland, n.d.). https://www.auckland.ac.nz/en/on-campus/facilities-and-services/university-of-auckland-clinics/hearing-and-tinnitus-clinic.html
“Specsavers Optical group ltd”, a British multinational optical retail chain operates mainly in the UK, Ireland, Nordic countries, and Australasia (including New Zealand). As well as selling glasses, many Specsavers also sell hearing aids. The first Specsavers selling hearing aids opened in Auckland in 2019 with plans afoot for more in the future. Their model is a “joint or shared venture partnership” where Specsavers also has shares in the franchise (“Specsavers,” 2021).
Costco has recently (2019) announced it is opening in New Zealand and will also likely sell hearing aids (Costco Is Coming to New Zealand, Changing the Way We Shop, 2019).
There have been some attempts to sell hearing aids over the internet. Thus far, there seems to be only limited success to this approach in New Zealand, but this may change in the future.
There have also been some attempts at practicing “Tele-audiology”, but this is not yet widespread. This may increase with greater use of cell-phone technology by patients due to hearing aids being linked to phones and developments in hearing aid software.
Table 2: Ear and Hearing Care Professionals in New Zealand
|Professionals||Approximate Number||Ratio to the Population|
|>403 (Nov 2018)||1:11,918|
|Otolaryngologists||100 (Jan 2017)||1:48,029|
|Nurse Practitioner||366 (March 2019)||1:13,122|
|Physicians||4,592 (Jan 2015)||1:1,045|
|Speech-Language Pathologists||942 (2018)|
|Teachers of the Deaf||>90|
|Hearing Therapists||>20 (2019)|
|Vision Hearing Screeners||unknown|
|Newborn Hearing Screeners||unknown|
|Advisors on Deaf Children||unknown|
(Health Work Force: New Zealand, 2017; Health Work Force: New Zealand, 2017a; HTANZ, n.d.; Ministry of Education, n.d.; Ministry of Health, 2014; Newborn Hearing Screening, n.d.; Nurse Practitioners in New Zealand, n.d.)
Audiologists in New Zealand are trained to carry out diagnostic hearing testing on both children and adults. This includes pure-tone testing for both air-conduction and bone-conduction, as well as some form of speech perception/discrimination testing, and immittance audiometry. Some may offer otoacoustic emissions testing in an adult setting, as well as APD testing. All have been trained to do ABRs, otoacoustic emissions, APD testing, and will have knowledge of vestibular testing. However, not all go on to use these last 4 skills on a regular basis, unless they choose to specialise.
Paediatric audiologists will be able to routinely perform ABRs, otoacoustic emission tests, and APD testing as well as fitting hearing aids to the paediatric and adult population.
Hearing aid selection, fitting (including Real Ear Measurements), and adjusting with counselling for adults are routinely offered by audiologists to the adult population especially in private clinics. Repairs of hearing aids and assessment of repairs are also offered in most clinics.
Less common are tinnitus, hyperacusis and misophonia specialists, and only a few private clinics offer auditory processing disorder testing and advice.
Vestibular audiologists have often been trained overseas. There are perhaps as few as 3-4 clinics offering vestibular testing in the whole country.
Cochlear implant counselling and mapping services are offered by specialist audiologists, but referral for a cochlear implant can be made by any audiologist, so long as the patient meets the current criteria.
The Ministry of Health contracts with two providers:
NZ$8 million per year is spent on cochlear implants and supporting services (Cochlear Implants, n.d.) This may be increased to NZ$16 million in 2021.
Otolaryngologists, Otologists & Otoneurologists offer private consultations and surgery, as well as public hospital work including surgery. Many do both public and private work. Most work part-time. Some otolaryngologists do contract work writing reports for the ACC (Accident Compensation Corporation) and determining if and how much of a particular hearing loss is due to one of the ACC-covered conditions. Some ear nose and throat specialists provide consulting services at audiology clinics with specialisations such as vestibular disorders.
Ear nurse specialists provide cerumen-removal services using microsuction. Some audiology clinics and some medical centres employ their own ear nurses to remove cerumen.
The New Zealand Audiological Society
The New Zealand Audiological Society is the self-regulating professional body of audiologists and audiometrists in New Zealand. Full membership is obtained after passing the NZAS-run exams, and after successful examinees’ names have been circulated to the membership for approval. Annual subscriptions are paid to continue membership (usually by employers), and continuing education points must be earned (over a 3-year cycle) to maintain membership. Peer reviews are also required for practicing audiologist/audiometrist membership to be maintained. Voting membership can be kept whether or not members practice audiology, so long as the annual subscription is paid, and sufficient CEPs are submitted. This results in not only active-member audiologists and audiometrists retaining a say in the profession, but also industry-based sales-representative members doing so, as well as those who may not have practiced audiology for decades. The NZAS organises an annual conference and has an executive council (elected by members), a salaried executive officer, and a secretariat. The NZAS runs OSCE examinations, the NZAS website, and handles complaints about members breaching the NZAS Code of Ethics. Non-members may not access government subsidies or funding on behalf of patients (Home » New Zealand Audiological Society, n.d.).
Regulation of Audiology
Neither audiology nor speech-language-therapy are registered health professions in New Zealand.
In New Zealand, 21 health professions are registered under the Health Practitioners Competence Assurance Act (2003) (Responsible Authorities under the Act, n.d.). Risk of public harm is one of the criteria that the Ministry of Health considers when looking at registration of a health profession. “Do the members of the profession want it?” is another consideration.
A survey carried out at the NZAS annual conference by independent audiologists NZ (IANZ) in 2018 showed that 97% of audiologists, audiometrists, and post-graduate student audiologists would like audiology to be registered (“No” = 1.16% and “Don’t know” = 1.74%). However, the NZAS Council indicate little or no interest in registration at this time (2018). Arguments against registration mainly focus on the cost (although smaller groups, such as Podiatrists, seem to manage this). Arguments for registration centre around name-protection for the profession, protection of the public interest, and a belief that self-regulation may be insufficient, or risks external interests having too much say in how audiology is run. There is also concern that the risk to the public of financial harm, cognitive harm, social-psychological harm, and other harms may be greater without registration. Only practicing and currently qualified clinicians may hold membership of a registered health profession, and many non-practicing or former audiologists may feel excluded by the registration of audiology, despite being able to retain membership of the NZAS if they choose to.
Legislation covering hearing aid services
Section 88 of the Hearing Aid Services Notice
In the absence of a Regulatory Board for Audiology, in 2011 the Ministry of Health (in discussion with the NZAS, Independent Audiologists NZ, and the Hearing Industry Association) added Section 88 of the Hearing Aid Services Notice to existing legislation. This was updated in 2016. In 2011, clinics were obliged under the legislation to tell the Ministry if they were owned by a manufacturer. Now, under one of the 2016 changes, clinics are obligated to give their patients the same information. Other areas covered deal with running a financially sound business, and operating clinically-sound practices, as well as knowledge of who may access MOH-funded subsidies and funding and what requirements they must meet to do so. Occasional audits of clinics are undertaken by the Ministry of Health.
The Health Practitioners Competence Assurance Act (2003)
The purpose of this Act is to address issues of safety and competency in provision of health services, and to ensure ongoing quality control among health practitioners. All health practitioners are covered by the act, whether registered under the act or regulated by a voluntary professional body (Health Practitioners Competence Assurance Act, n.d.). The Health and Disability Commissioner also issues a Code of Health and Disability Services Consumers’ Rights, and health practitioners including audiologists must also make sure that they abide by the relevant consumer rights (eg Right 2: the right to be free from…coercion, harassment…and financial or other exploitation) (Code of Health and Disability Services Consumers’ Rights – Health and Disability Commissioner, n.d.).
The Privacy Act 1993
This Act deals with the collection and disclosure of personal information, and audiologists must be familiar with and abide by its provisions when handling patient information (Privacy Act 1993 No 28 (As at 01 December 2020), Public Act Contents – New Zealand Legislation, n.d.)
Audiology is not a registered health profession in New Zealand. This means that there is no legal protection for the title “audiologist”, and anyone can call themselves one, regardless of their qualifications. However, to become an audiologist (and more recently, an audiometrist) who can access Ministry of Health hearing aid subsidies and funding on behalf of patients, you must be a full (active) member of the NZ Audiological Society, a voluntary and self-regulation association. The NZAS runs an annual conference for their members, as well as investigating complaints against members, and upholding a Code of Ethics.
In order to become an audiologist in New Zealand who can access government funding (for hearing aids) on behalf of patients needing audiological services, you must have been an under-graduate (preferably with a science-related degree) and complete a two-year Masters in Audiology (M.Aud). This is followed by clinical work and the achievement of a Certificate of Clinical Competence, granted by the NZ Audiological Society.
Audiologist Scope of Practice
Scopes have been developed with input from audiologists over many years, and with reference to Australian, Canadian, British and American standards.
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Audiometrists in New Zealand who wish to apply for NZAS membership must successfully complete a recognised qualification in audiometry, where core competencies have been acquired and assessed during a qualification process as agreed between ANZAI (the society for audiometrists: (Anzai | Association of New Zealand Audiology Incorporated, n.d.). NZAS, the University of Canterbury and the University of Auckland). An audiometrist must have at least two years’ work experience after completing a recognised qualification in Audiometry.
Audiometrist Scope of Practice
Audiometrists’ scope covers hearing assessments and hearing aid fitting and adjustments in non-complex adult cases. They may manage selected hearing aids fittings and adjustments as directed by an audiologist. Audiometrists may treat adults, but not children. Please visit https://www.audiology.org.nz/for-the-public/what-is-audiology/audiologist-and-audiometrist-what-is-the-difference/ for more details.
Hearing Therapists. The Hearing Therapists group (Life Unlimited) is a charitable trust funded by the Ministry of Health. Hearing therapists can provide advice and screening hearing tests and visit people in their homes to assist them with, for example, special telephones and doorbells, as well as help when someone needs practice to use or insert a hearing aid. Hearing therapists can work closely with audiologists (HTANZ, n.d.; Life Unlimited – Health & Disability Services | Advice | Support, n.d.).
Advisors on Deaf Children. These are funded by the Ministry of Education and work alongside children identified as being deaf or hearing impaired and their families from birth until leaving school. They work with other services including the two deaf education centres and help with communication resources (Ministry of Education, n.d.)
Deaf-Blind coordinators. Government funded, they work with people who have both hearing impairment, and are registered as blind with the Blind Foundation. They help coordinate relevant services, and will even drive people to appointments, such as with their audiologist (Blind Low Vision NZ – Support for Kiwis Who Are Blind or Have Low Vision, n.d.).
The National Foundation for the Deaf, consumer and advocacy group.
Deaf Aoteraroa, consumer and advocacy group (member of World Federation of the Deaf).
The Hearing Association, nationwide consumer and advocacy group (with local branches run by volunteers).
Examples of funding bodies which may give grants for hearing aids.
The majority of research within New Zealand into audiology and audiology-related topics is undertaken at the Universities of Auckland and Canterbury. Auckland University is also the home of the Hearing and Tinnitus clinic, a centre for research into tinnitus and hyperacusis (Hearing and Tinnitus Clinic – the University of Auckland, n.d.).
Audiologists face many challenges in their dealings with various groups.
Governments have many demands on limited funds.
One of the challenges to audiology as a profession in New Zealand is that corporate lobbyists may have persuaded government officials that audiology is only about selling hearing aids. Audiologists have contributed to this by bundling all their services into the cost of hearing aids. The device is elevated above the service and skills of a professional audiologist (in a broad range of activities including diagnostics); and there may be a general lack of knowledge regarding the fitting of an aid being a process over time, involving neuroplastic changes, computer adjustments, education, and counselling. This device-centric view is supported by the government insisting that the subsidy is for the wholesale cost of a hearing aid. If that wholesale cost is less than the subsidy, then the full subsidy must not be applied for, even if the full subsidy would help those in financial difficulty pay for the service of fitting the aid.
Government may place insufficient value on what the audiologist does (vestibular audiology, hyperacusis treatment, intra-operative monitoring, etc), instead placing a monetary value on the device; a focus that suits manufacturers of devices. It does not appear to recognise the full scope of the profession of audiology, nor the complexity of patient need and patient-centred care. Audiologists are easily viewed in some sectors as salespeople (rather than health professionals). This view is exacerbated because audiologists are not members of a registered profession. Additionally, the device focus is not likely to assist with achieving registration for the audiology profession.
The government, of course, is most interested in affordability of hearing aids for segments of the population with limited finances, as that is a measurable parameter. Long-term outcomes, such as cognitive abilities over the long-term, educational and employment success, and hearing aid fitting success, are more challenging to measure.
The New Zealand Public
The challenge for audiologists is to put our clients/patients at the centre of what we do. This involves listening to them, among other things. This may also involve educating them that hearing aids are not like glasses; auditory sensory cells are damaged in a way that retinal cells in the eye are not. Fitting hearing aids involves retraining the brain, over time. People want good service, but they would like it to be low-cost, or free. They would also like hearing aids to be cheaper. Because prices for audiology services have traditionally been bundled into the cost of hearing aids, there is a lack of understanding that audiology services are payable.
The NZAS and the Profession of Audiology
The NZAS might, in the future, spend more time educating the New Zealand public about the benefits of good audiological practice as a way of boosting the profession. However, the challenge will be to address the device focus of public funding and public perception. NZAS faces the challenge of reconciling their lack of support for professional registration with gaining recognition for important services required for effective diagnosis and treatment of hearing and balance disorders. Of concern to the NZAS is that audiologists and audiometrists might not opt to belong to both a compulsory registration board and a voluntary professional association. NZAS partnerships with industry such as a one they hold with the Hearing Industry Association present a challenge for clinics who seek to promote their services as their primary purpose. In future, audiologists’ scope of practice may be extended to remain relevant and current.
Manufacturer-owned and Corporate-owned Clinics.
Corporate clinics, for their part, must make profits for their shareholders – how to increase these and survive challenges posed by internet sales, or extreme competition (“Two for the price of one” and offering free hearing tests and follow up services) – or any competition – is a challenge for audiologists who are the employees who generate income, in contrast to management who are typically not audiologists, but are business managers. International transfer pricing activities may allow corporate companies to have high sales volumes in New Zealand yet pay little or no tax in New Zealand.
Independent clinics in New Zealand face several challenges. One is that their suppliers belong to groups that own the clinics that are their competitors. Another is that the high salaries and bonuses offered by large corporates to graduate audiologists has made hiring audiologists more expensive across the board. Additionally, large overseas-owned clinics have preferred-supplier agreements with insurance companies operating in New Zealand, such as IAG and AA. If an aid is lost or damaged, the patient is contacted directly by a corporate clinic and told they must go to that corporate clinic. However, because hearing aids are classified as medical devices in New Zealand, they are covered by the Health and Disability Act and Code of Patient Rights (Code of Health and Disability Services Consumers’ Rights – Health and Disability Commissioner, n.d.). This states that patients may choose their own provider, and that an appointment may not be made for them without their informed consent. Many choose to return to their original provider if they are made aware of this.
New Zealand is a very small country. Word-of-mouth and personal relationships with health practitioners are extremely powerful factors when New Zealanders look for health providers, including audiologists, and this may be one of the reasons that smaller clinics are still thriving (PatientEngagementHIT, 2017).
ACC – home. (n.d.). ACC. Retrieved May 19, 2018, from https://www.acc.co.nz/
Anzai | Association of New Zealand Audiology Incorporated. (n.d.). ANZAI – Association of New Zealand Audiology Incorporated. Retrieved Feb 18, 2018, from https://www.anzai.org.nz/
Audiologist salary in new zealand | payscale.
Jeanie Morrison-Low isa practicing audiologist,full audiologistmember of the NZAudiological Society, and owner of Kapiti Hearing Ltd, an independentaudiology andhearing aidpractice with twofull-time clinicsnear Wellington in the North Island ofNew Zealand.She is currently the chair of Independent AudiologistsNZ.