Reconciling true and incurred costs of blindness in New Zealand.

• Author: Godfrey, A. Jonathan R.
• Position: Report

Abstract

In 2003 the Royal New Zealand Foundation of the Blind commissioned independent research to gain a greater understanding of the costs of blindness faced by its 11,300 blind, deaf-blind and vision-impaired members. The most common cost incurred by survey respondents was that of taxi use, which is used in this paper as an example of the difference between an incurred cost and a true cost of blindness. This difference is initially discussed in a qualitative framework, and then quantified. The survey data showed that many blind and vision-impaired individuals face restrictions on their use of such services as taxis due to their limited financial resources when mitigating the effects of their vision loss. This paper demonstrates why the constraints on expenditure need to be identified in order to provide better estimates of the true costs of blindness. These findings have relevance for the planning of any future investigations into the costs of disability or other similar social research.

INTRODUCTION

New Zealand is just one country where the costs of disability are partially funded through the provision of welfare support payments. The level of these payments must be set at a realistic amount to help meet the social policy objectives set by the Government for its community of disabled people. In turn, these policies need to be determined using accurate information about the actual cost of disability.

In 2003 the Royal New Zealand Foundation of the Blind (RNZFB) commissioned research into the costs of blindness in New Zealand. At that time the membership of the RNZFB included approximately 11,300 people who met the eligibility criterion that "In the opinion of a registered ophthalmologist or optometrist the person's visual acuity does not exceed 6/24 in the better eye with corrective lenses, or there are serious limitations in the field of vision generally not greater than 20 degrees in the widest diameter." (1) The membership of the RNZFB is growing, and stands at approximately 11,700. (2)

The vast majority of the RNZFB's membership are 65 years of age or older, with approximately half its members over 80 years of age. While it may be interesting to investigate the quality of life for these older people and attempt to determine a financial cost for the reduction in the quality of life that results from vision loss, it is the working-age blind and vision impaired whose access to work and other aspects of social inclusion that have received the most scrutiny.

The increase in the development and implementation of "welfare to work" policies has, and will continue to have, an impact on the approximately 3,000 RNZFB members of working age. The merits of such policies are not considered in this paper, but this discussion may help inform the debate about how governments may wish to compensate for the costs of disability that arise as a direct consequence of an inaccessible society. The New Zealand Disability Strategy clearly recognises the social model of disability in preference to the medical model (Dalziel 2001), and it is in this vein that the current investigation was carried out.

The true cost of blindness could be defined as the total amount of extra time, money and other resources that a blind or vision-impaired person must expend or have expended on their behalf to attain the same quality of life as their sighted peers. The research commissioned by the RNZFB gave an analysis of the incurred costs for 200 respondents. However, the use of incurred costs has limitations when relating these costs to the definition of the true cost of blindness presented here. For example, no attempts were made to deal with reduced opportunities, whether through lost income, reduced avenues for recreational activity or the effects on interpersonal relationships.

The primary analysis was based on survey questions that were determined by the independent researchers using knowledge gained from the literature and from focus group sessions (Gravitas Research and Strategy Ltd and Market Economics Ltd 2006). The survey respondents were not a simple random sample of RNZFB members, with the working-age membership being over-sampled. Stratified random sampling was used, and this forced the primary analysis to incorporate the use of survey weightings when estimating average costs for all blind people. This paper does not address the quality of the data collected in the primary analysis. There are reasons why the data may be regarded as inferior, but the primary analysis is the best that has been conducted in New Zealand. Researchers wishing to undertake costs of disability research in the future should refer to that report and consider the decisions taken by those researchers separately from this supplementary analysis.

The quantitative data were collected during 2004 using a telephone-based survey questionnaire, chosen because of the inability of the target population to use other forms of data collection. It showed that a diverse range of costs were incurred, but, notably, the cost most frequently incurred by respondents was the use of taxis to undertake non-optional short-distance travel that was for purposes other than getting to work. This incurred cost should therefore take account of only those expenses that were borne by the survey respondent, but it is unclear whether the cost includes any subsidy through avenues such as the Total Mobility Scheme, which is not available to all blind people living in New Zealand due to geographic differences in the coverage of that scheme.

Anecdotal evidence suggests that taxi usage is the most-often questioned cost because taxis are often considered to be an...