Wellington neurologist Stuart Mossman questions why the hearing impaired are being denied what other countries consider to be basic medical care and urges the Government to deliver on its pre-election pledge to increase adult cochlear implant funding.
Stuart developed increasing deafness as an adult and was able to access a cochlear implant that significantly improved his hearing. The government did not fund Stuart’s cochlear implant surgery. His hearing was only restored because he could afford to pay for the $50,000 procedure himself.
A cochlear implant didn’t just restore my hearing. It meant I could continue practising medicine.
I was in my mid-50s when my world started to mumble. I thought my wife had developed a lisp, and I could not hear my patients without standing very close to them. Hearing aids proved ineffective and I realised that I should not, and probably could not, continue in medicine. My communication was becoming too unreliable.
A cochlear implant was the only viable treatment that could restore my hearing. I was otherwise faced with the prospect of losing my career and, by necessity, becoming fairly reclusive.
I was assessed by the Southern Cochlear Implant Programme (SCIP) and, unfortunately, I did not meet the somewhat restrictive government criteria for a cochlear implant. A lack of government funding also meant it was very unlikely that I would ever receive one, regardless of whether I was eligible.
By this time I was fairly desperate, and was prepared to pay privately. I received my first cochlear implant in 2016 – and the comparison to being without it is best described as chalk and cheese. I can now hear my patients, participate in family conversations, and remain a productive member of New Zealand’s medical workforce.
Indeed, it is only with the benefit of a cochlear implant that I have been able to continue as a neurologist.
The cause of my deafness is genetic and autosomal dominant – in other words, it was passed down to me through my family. Three relatives on my father’s side have cochlear implants – two privately and one through the public system, but only with the help of lobbying by his local Member of Parliament.
My father and his triplet brothers became profoundly deaf in their 60s, and were not in a position to afford a cochlear implant. Their communication was really only by the written word.
I count myself very fortunate. There are currently 269 New Zealand adults who continue to languish on the waiting list. For many of these people there is no prospect of ever receiving a cochlear implant, without an increase in funding.
In 2013 the country spent more than 100 million on knee replacements1; that sum alone, for one year, would clear the existing cochlear implant wait list and keep the programme running sustainably for a period of more than five years.
It is also a little-known fact that cochlear implants are not covered completely by health insurance – either you are one of the 20 percent lucky enough to be publicly funded, or you have to pay for the procedure privately.
Those on the SCIP waiting list range in age from early twenties to late eighties. Occupations include nurses, engineers, army, teachers, bankers, butchers, farmers, factory workers, highway maintenance, business owners and retail workers. Many patients have had to leave their job due to their hearing loss.
There is therefore a strong economic argument for increased funding. The tax that I have been able to pay during the last three years is equivalent to at least three government-funded cochlear implants.
The government would not have received that tax if I didn’t have a cochlear implant – as without it, I would not be working.
A Deloitte report estimates the cost of hearing loss to the New Zealand economy in 2016 was $957.3 million – the majority (58 percent) of which was related to loss of productivity2.
The report concludes that hearing loss is a significant issue facing the New Zealand population, and those affected can experience high barriers to related services, recognition and support.
New Zealand also lags behind other OECD countries in terms of adult cochlear implant funding – including Brazil, Australia, the UK and Germany. In 2017, 547 Australian adults received cochlear implants3. On a per capita basis, this is more than twice the numbers funded in New Zealand. Furthermore, cochlear implants are guaranteed to Brazilians of all ages through the national health system4.
Thus, the question remains – is basic medical care being denied to New Zealand adults who can’t afford to pay for their cochlear implant privately? We need to continually challenge government on this issue. New Zealanders should not need to buy their hearing back.
It could also be argued that it is economic mismanagement not to optimise people’s function so that they can continue in the workforce, let alone for other obvious reasons.
The Labour Government’s pre-election health policy included investing an extra $28 million (over four years) toward adult cochlear implants. If implemented, an additional 80 adults every year could receive access to this life-changing technology. New Zealand’s two cochlear implant providers, the Southern and Northern Cochlear Implant Programmes, continue to advocate on behalf of patients to ensure Labour delivers on its promise.