Presentation provided at the workshop with the European Commission on Accessibility and Assistive Technology studies.
Presentation provided at the workshop with the European Commission on Accessibility and Assistive Technology studies.
Study on the Internal Market for Assistive ICT Workshop: eAccessibility and Assistive Technology 21 June 2011 Mar Negreiro Sebastiaan van der Peijl
Aims and objectives Whyassistive ICT? Context: policy, disability in the EU, State of Play in the InternalMarketforAssistive ICT Service Delivery Models: barriers and opportunities Demandforassistive ICT: barriers and opportunities Supply-side of assistive ICT: barriers and opportunities Estimating the marketforassistive ICT Scenario Analysis Conclusions Recommendations Contents
Aims and objectives Main research question: “What are the main barriers and opportunities today in the European Internal Market for Assistive ICT, and what could be gained from addressing barriers and embracing opportunities in the market for Assistive ICT?” Activities:
Extensive desk research, interviews at EU and Member State level (54 interviews):
Policies and approaches to implementation of national support schemes (service delivery to people with a disability) in 9 Member States (ES, DE, DK, FR, IT, LV, NL, SE, UK) across three life environments: Education & Training, Work, Independent living;
Desk research and interviews at EU level (14 interviews):
7 Case Studies:
Investigating trends, gathering evidence, analysing barriers and opportunities
Propose recommendations for improvement, building on the advice of experts and relevant stakeholders.
Current situation: More than 80 million people in the EU age 16-54 years with some form of disability (16,2% average disability rate); The rate of disability increases with age: an estimated total of 84-107 million people in the EU;
Citizens with the aspiration and the right to live their lives as an integrated part of the European society
In today’s information society this right must be ensured: ICT is an integral part of everyday life: in education, work as well as the home environment; However, mainstream ICT is often designed taking into account the needs of all potential users;
Need for additional products or services or specific adjustments are needed to tailor to the specific needs of persons with a disability
e.g.: a special keyboard, software that reads out text from the screen, or alternative controls for any type of ICT (e.g. computers, phones, ATM, etc.) in any environment (e.g. at home, in school or at the workplace); However, the poverty rate of people with a disability is 70% higher than average;
Need for support schemes in the Member States
Why assistive ICT?
What is assistive ICT? Education & Training Work ICT External assistive ICT Accessible ICT Embedded assistive ICT Independent Living Why assistive ICT? Assistive Technologies that enable accessibility and usability of mainstream Information and Communication Technologies (ICT) by addressing and overcoming deficiencies in the design of ICT that pose barriers for people with a disability, applied in the Work, Education & Training and Independent Living environments.
Context: EU policy UN convention: signed and ratified by the EU, signed by all MS (ratified by 17), protocol signed by 22 MS (ratified by 14) European Disability Strategy (2010-2020): equal rights, dignity, treatment, independence, full participation
Accessibility: improving the availability and choice of assistive technologies, public procurement
Participation: e.g. use of sign language, Braille, accessible websites and copyrighted works, etc.
Employment, education, independent living, health: focus on sound working conditions, personal-assistance schemes, legal and organisational barriers, inclusive education, non-discriminatory health services and facilities, disability part of curricula of health professionals
MS cooperation: information exchange and policy coordination (High Level Group on Disability)
Context: disability in the EU Market demand: people with a disability in the EU Only cross-country dataset available today is the Ad-hoc Module on Disability from the 2002 Eurostat Labour Force Survey Issue: how to define disability?
Context: disability in the EU Life environments: Education: provision of assistive ICT is important, however, often no common minimum denominators for provision of assistive ICT are in place; Employment: providing reasonable accommodation Independent living: an ageing society means a growing share of people with a disability that could be supported through assistive ICT
Context: providingassistive ICTService Delivery Models Service Deliver Models (SDM): Member States’ support schemes implemented by (public) service providers Disability organisations (e.g. associations, charities, NGOs, etc)
Context: providingassistive ICTService Delivery Models Three types of service delivery models:
People with a disability are generally not the final decision makers
Service providers act as advisor and funding provider
People with a disability, or a representative, are the final decision makers
Source: Robotiker–Tecnalia, 2009
State of play in the Internal Market for assistive ICT Estimating the market is difficult due to lack of data No recent and consistent data on people with a disability on the EU level (only 2002 LFS Eurostat) No quality data on take-up of ICT by people with a disability (some MS-data) No quality data on take-up of assistive ICT (some studies (MEAC, AEGIS)) Little data on public expenditure on assistive ICT (some data in e.g. NL GIPdatabank) No consistent data on the assistive ICT supply (except national databases on Assistive Technology)
State of play in the Internal Market for assistive ICTMarket supply Market supply: lack of data No official statistics available on assistive ICT companies, production, sales, etc. This makes it hard to estimate the market The only available centralised source of information are the national databases on assistive technology kept by a number of Member States and provided through EASTIN Danish EBST survey (2009): 70% of AT in Denmark procured by public service providers; The market consists of mostly small highly specialised companies; Most companies focus on the local market: over half do not export, only 2% export nearly all their products (91-100%). United States BIS AT survey (2003): Europe: the largest export market for US based AT companies; Particularly Denmark, Germany, Sweden and the UK.
State of play in the Internal Market for assistive ICTService Delivery Models Support schemes in the Member States
Across Member States, life environments and regions within Member States the support schemes in place and the approach to service delivery differ significantly, in terms of:
Actors involved: e.g. municipalities, regional administrations, public employment services, public health services, education institutions, health insurance. Level of coverage / support: full coverage (including assistive ICT product, maintenance, upgrades), partial (end-user covers part of the costs), none (in some cases many of today’s assistive ICT devices are not covered). Type of support: provision of assistive ICT in ’natura’ (limited to lists of eligible products, or ‘positive lists’), personal budget, vouchers, reimbursement. Ownership: owned by organisation providing the device (leasing), owned by end-user.
These differences imply different types of service delivery and have an impact on the market.
State of play in the Internal Market for assistive ICTService Delivery Models Service Delivery Models
Service providers play an important role in the value chain: financing and procurement
Source: Robotiker–Tecnalia, 2009
State of play in the Internal Market for assistive ICTService Delivery Models Government support differs widely across MS and life environments, even regions: different actors involved, differences in prescription or reimbursement processes, different types of procurement, different governance models (more or less decentralised),
State of play in the Internal Market for assistive ICTService Delivery Models Government support differs widely across MS and life environments, even regions: different levels of coverage (ranging from full reimbursement models to none, depending on the country/region), differences in eligible products...
State of play in the Internal Market for assistive ICTService Delivery Models Government support differs widely across MS and life environments, even regions: Different levels of influence of the end-user...
The most prevailing type of SDM is the medical/social model Freedom of choice: often none (limited to lists), but more freedom of choice schemes are being implemented (e.g. DE, DK, NL, SE) SDMs have an important influence, they are the main buyers on the market State of play in the Internal Market for assistive ICTService Delivery Models
State of play in the Internal Market for assistive ICTService Delivery Models Overlaps between the different systems across the life environments can result in unclear responsibilities Disabled people face a complex environment Assistive ICT companies similarly face a complex environment
State of play in the Internal Market for assistive ICT Main findings Demand: End-userperspective Service Delivery Models High efforts to getaccess to funding and the right solutions Lack of information / independent advice Different actors in the life environments Limitedchoice Difficultieswith overlap in different life environments Different levels of coverage Supply: Company perspective De factorestrictionsonmarket entry Smallproduction volumes Different types of support Non-transparentpricing, canlead to high prices and pricedifferences Localised Markets Long supplychains In some cases: high margins Need to workthroughlocaldistributorsorlocalpresence High investmentformarket entry Limited cross border trading within the InternalMarket
State of play in the Internal Market for assistive ICT A complex reality… The market structure for Assistive ICT can be characterisedby ‘supply push’: companiescompete to get in the SDM system, lowerattention to end-users Somekeydimensionsemerged and wereaddressed in the analysis and through case studies People with a disability Manufacturers / Distributors of Assistive ICT Service Delivery Models Supply push
Service Delivery ModelsS.W.O.T. Strengths: In the work environment, support schemes are usually well defined, supported by the focus on reasonable accommodation; Weaknesses: Levels of support and types of support vary across MS and life environments Complex environment: many different actors, procedures, etc. Single points of access are hardly established, with exceptions in e.g. DE, FR In education support schemes are generally weakly defined Opportunities: Freedom of choice schemes are on the rise, either with a reimbursement or personal budget scheme (e.g. DE, DK, NL, SE) Function vs. Form debate: functional descriptions of products eligible for funding (e.g. NL, SE) Growing ageing population: market opportunity and potential to reduce costs Threats: Product lists limit choice and impact the market Provision of assistive ICT in education is important from an early age
Case Study: Freedom of choice in SwedenFritt Val Fritt Val Pilot Aim: increased quality of life, empowering people with a disability, freedom of choice 3 participating county councils: Kronoberg, Sodermanland, Stockholm Funding through vouchers: Voucher = purchase price (county council) + 30% + VAT Results: User empowerment: Better informed, better choices, greater satisfaction Try out opportunities are important Stimulating the market: Increased competition: larger number of suppliers, lowering of prices, increased service delivery / bundling Closer relations with the customer Opportunities for small manufacturers Scope for use of e-Commerce Opportunities for mainstreaming: function vs. form debate Service providers: New role, change of attitude (responsibility and legal consequences, some resistance) At no additional cost Potential for: more user focus, better information provision, more competition.
Case Study: Personal budget in GermanyPersönliches Budget Self-payers for a ‘support mix’ (including assistive ICT) Self determination; statutory entitlement to personal budget since 2008 Introduction of one-stop-shopping (8 types of funding providers) & freedom of choice Money Funding agencies (no one-stop-shopping) Manufacturers / Distributors Agreement on quantity, quality, etc. Provision of goods and services Entitlement to the goods and services provision Beneficiaries Purchase of goods and services Money Funding agencies (one-stop-shopping) Manufacturers / Distributors Beneficiaries Agreement on quantity, quality, etc. Target agreement
Case Study: Personal budget in GermanyPersönliches Budget Results Implementation still resisted by some public agencies: Fear of loosing control over: the system, the quality, type of fundable devices Fear of higher administrative costs Non-standardised admin procedure and faulty individual target agreements Resulted in additional admin burden and lack of cooperation Impact on people with a disability General satisfaction reported (91%) However, heavy reporting obligations Used where the traditional system fails Expected to grow but lack of awareness Stimulating the market: Incumbents manufacturers/distributors: reluctance Insufficiently developed market offer Critical mass: new user group expected to emerge, more competition and innovation Transition issues, but expected to grow
Service Delivery ModelsBarriers and opportunities
Demandforassistive ICTS.W.O.T. Strengths: Eurostat provides data: LFS and use of ICT by elderly (also Senior Watch I and II) Initiatives for try-out sessions, online resources (e.g. national databases, product comparisons) are important to provide information Weaknesses: Data on people with a disability are difficult to compare across countries, due to different definitions of disability, no data on take-up of assistive ICT; Lack of user friendly information aimed at people with a disability (end-users); Information in national AT databases is aimed at service providers rather than end-users. Opportunities: Harmonised data collection could allow increasing awareness: potential market size, benchmarking across MS; Projects like AEGIS have shed light on use of assistive ICT; More information aimed at end-users helps empower them. Use of online platforms for information exchange is important (e.g. product ratings, comparisons, etc) Threats: Lack of data makes it difficult to estimate the actual market size, which can lead to underinvestment and unclarity on actually reaching the target group; Lack of awareness and information leaves people with a disability less empowered.
Case Study: Information provision Local Blind Societies (UK) Need for ‘good information’ for informed decision making Resource rooms: try-out, equipment demonstrations, borrowing, outreach and home visiting, conferences, exhibitions, information days; Enhancing information provision to compare products and prices; Services close to the user: ‘second-tier’ assessments, hands-on training, peer-to-peer contact; Geographically close to users, no registration required; Established networks with: suppliers, agencies, technology networks, education& training inst. / employers, end-users; Training for professionals. Filling the gap: enabling blind people, market facilitation Lack of awareness of health services staff, information at point of diagnosis; Greater outreach, closer relations enabling inclusion; Facilitating market access.
Case Study: Information provision RETADIS (Spain) Try out assistive ICT: 26 centers throughout Spain with computers and assistive ICT + 50 private home-users; RETADIS social network: contact with peers, forums, newsletters; Training by occupation therapists and for education and work. Filling the gap: bringing together different stakeholders Bringing together stakeholders, manufacturers, end-users, occupational therapists for better information and hands-on experience; Using online tools to connect people and provide support: acquiring new skills, online social interaction; Providing advice and connecting to suppliers; Need for suppliers to reach out to people with a disability.
Demandforassistive ICTBarriers and opportunities
Supply of assistive ICTS.W.O.T. Strengths: National AT databases can provide a closer look into the supply of assistive ICT in terms of number of manufacturers / distributors; The trend towards freedom of choice can strengthen competition and focus on the actual needs of people with a disability; Assistive ICT companies and research centers do bring new solutions to the market Weaknesses: Very little information is available on the assistive ICT companies : e.g. market shares, cross-border trade; Little information is available on prices and price differences across MS prevail; Public procurement makes up the large share of procurement in the market, however pricing is not transparent; Complex supply chains and requirements for public procurement create significant barriers to trade across the Internal Market; Lack of presence of one-stop-shops for assistive ICT. Limited nr of assistive ICT companies involve end-users in the design of their products. Opportunities: Market surveys (e.g. BIS AT, EBST Danish survey) could be conducted at an EU level; Increasing amount of information on low costs AT (e.g. through Albacete in Spain, Raising the floor); Common standards and streamlined procurement could help create a more homogenous market; e-Commerce platforms can provide more transparency and information and increased competition; A more consumer oriented approach can ease market entry and bring good solutions to market. Threats: Lack of information hampers competition and innovation; Barriers to trade limit development of assistive ICT and trade across the EU; Price differences can undermine trust, limited transparency and public procurement for product lists hampers competition;
Case Study: Pricing of assistive ICT Reasons for differences in prices across Member States: Long supply chains, distributors set their own margins; Localisation costs: e.g. different language versions; Bundling: after sales services included in sales price; Difficult to compare: rebranded products, different versions sold in different countries; Set levels of reimbursement influence pricing (FR: Poletti report, CNAS-Alcimed) Lack of transparency: prices are hard to obtain;
What the market will take
Case Study: Supply of assistive ICTAnalysis of national AT databases Screening of national AT databases for an improved market view General problem: General lack of information on supply side of assistive ICT market Idea: Screen national AT databases for companies providing assistive ICT devices Issue: Available information is partially inconsistent across databases General conclusion: The analysis adds insight, but the market remains opaque
Case Study: supply of assistive ICTAnalysis of national AT databases Methodology Center of interest: assistive devices under ISO 9999:2007 subcategory 22 “assistive products for communication and information” in 8 national AT databases Problem: Not all devices in ISO 9999:2007 subcategory 22 can be considered as assistive ICT devices !!! Solution: Screening ‘company-by-company’ or ‘product-by-product’
Case Study: supply of assistive ICTAnalysis of national AT databases 810 different assistive ICT companies in 8 countries Supply side of national markets for assistive ICT is fragmented in most countries 945 assistive ICT companies in total in 8 countries Accounting for multiple presence of identical companies in different countries, we count 810 different assistive ICT companies in 8 countries. * Note that the definitions for France have been adapted as follows to fit the table: manufacturers = manufacturers, importers = distributors, manufacturers-importers = manufacturers-distributors.
Case Study: supply of assistive ICTAnalysis of national AT databases Little cross-border presence: Most companies are only present in 1 country; Most foreign companies are from the USA, UK and Germany;
Case Study: supply of assistive ICTAnalysis of national AT databases Fragmentation: narrow markets, mostly SMEs On average the companies are present in only 1-2 product groups Qualitative insight: many micro enterprises and niche players with a very restricted product range (less than 5 products)
Supply of assistive ICTBarriers and opportunities …
Estimating the marketforassistive ICT Estimating demand for Assistive ICT Lack of data on both the population and the take-up of assistive ICT Assessment of internet and mobile phone uptake: Estimation of the population of people with a disability Estimation of internet uptake Estimation of assistive ICT uptake Use of mainstream ICT Use of the internet Use of mobile phone Mobile phone use by people with a disability and 65+ Internet use by people with a disability and 65+ Supported by assistive ICT Supported by assistive ICT
Estimating the marketforassistive ICT Methodology: estimating internet uptake: Basedon a set of availablevaluesforsomecountries; Estimatingexpectedvalues.
Estimating the marketforassistive ICT Methodology: internet uptakeratesforpeoplewith a disability Applying the expected values to the Member States; Calculating the absolute figures: current market potential of roughly 29 million people.
Estimating the marketforassistive ICT Methodology: assistive ICT uptakeratesforpeoplewith a disability Based on results of the AEGIS study: 1/3 uses assistive ICT when accessing internet; Roughly 10 million people estimated to make use of assistive ICT when surfing the internet
Estimating the marketforassistive ICT Mobile phoneuptake: Mobile phoneuptakebypeoplewith a disability is close to that of the generalpopulation (aged 15-64); About 66.8 millionpeoplewith a disability are estimated to use mobile phones in the EU; According to AGEIS about 32% of mobile phoneuserswith a disabilityuseassistive ICT; About 21,4 millionpeopleusingassistive ICT for mobile phoneuse. Main results: Estimation of more than29 milliondisabledpeopleusing internet in the EU in 2009 21 millionaged 15-64, 8 millionagedabove 65 Estimation of 9.86 million EU citizens already using assistive ICT to access the internet in the EU and about 21.4 million for mobile phones; Large existing disparities in uptake, especially for old people; Internet uptake is increasing fast.
Scenario analysisDemand: informed & empowered users Freedom of choice, drivers: User empowerment Role of (public) service provider Functional description of needs Mainstreaming e-Commerce Awareness and information, drivers: Digital literacy Close relationship with consumers Multi-stakeholder approach Independent information / advice Training
Scenario analysisSupply: competitive supply of A-ICT Competition, drivers: Transparency Competition IN the market not FOR the market Barriers within the market e-Commerce Pricing, drivers: Transparency Supply chain Comparing Knowing what you pay for
Scenario analysisDemand pull and supply push growth Demand: informed and empowered consumers Scenario 1 Scenario 2 Scenario 3 Scenario 4 Supply: competitive supply of assistive ICT
Scenario analysisToward a consumer oriented market User empowerment, more transparent market, closer customer relations, more cross-border trade, changing the role of (public) service providers
Scenario analysisImpact on the market: forecasting exercise Based on internet uptake:
Scenario analysisImpact on the market: forecasting exercise Impact on internet uptake
Scenario analysisImpact on the market: forecasting exercise Impact onassistive ICT usage
Scenario analysisImpact on the market: forecasting exercise Estimates are based on assumptions and are projected in accordance with the S-curve of the Netherlands Actual internet take-up developments depend on many exogenous factors, such as general development of internet connections (infrastructure), digital literacy, etc. Yet, this analysis shows the expected direction, although country specifics should be taken into account This also shows that currently there is a large unexploited market potential
ConclusionsThe impact of the role of government Public procurement: Can reduce cost (e.g. volume contracts) But leads to competition FOR the market not IN the market: i.e. market distortion Result: a heterogeneous EU Market (mainly local markets), limited economies of scale for producers, limits incentives for R&D and investment Information provision: Training of professionals in the SDM is essential End-user should be aware and well informed Funding: Uneven across MS, as well as prices paid by the SDM
ConclusionsFunction vs Form Away from ‘positive lists’ of eligible products… Keeping positive lists up-to-date is cumbersome or simply not happening (e.g. IT) It can take a lot of time for new products to become ‘eligible’ …towards a function based approach (with possibly a ‘negative list’) A function based approach opens up opportunities for new products, innovation A function based approach enables choice and user empowerment
ConclusionsTowards a Consumer Oriented Model Empower people with a disability: decision makers Encourage interaction between companies and end-users: closer customer relationships, more information aimed at people with a disability (direct marketing, try-out sessions) Scope for reduced prices (e.g. SE) Mentality change: SDM becomes principally advisor and funding provider Single access points, across life environments
ConclusionsIncreasing information provision & awareness Information provision: essential for professionals and end-users, the internet offers important opportunities (e-Commerce, product reviews, etc) Empowerment: more focus on desirable products (less stigma) Training: also essential for both end-users and professionals Maintenance, upgrades: clear rules are needed
ConclusionsSupply Market fragmentation: mostly local markets, small companies Lack of transparency Distributors are essential today for local market access Long supply chains: high prices Focus on SDM reduces consumer orientation More consumer orientation opens possibilities for: easier market access more competition lower prices potentially better after sales services e-Commerce more information aimed at the end-user increased economies of scale and incentives to invest and conduct R&D mainstreaming: accessible mainstream solutions become attractive alternatives, incentives for Design for All
ConclusionsData availability There is a general lack of statistics People with a disability: wide divergence due to different applied definitions across MS, lack of cross-country comparable data Use of ICT and assistive ICT: only ad-hoc national measurements Supply of assistive ICT: definition of assistive ICT: ISO 9999 Cat 2? EU NACE has no classification for A-ICT, resulting in lack of data
Recommendations Shaping a more competitive and better functioning market for assistive ICT Improve the availability of data: common and consistent definition and measurement of people with a disability and their use of ICT and assistive devices need for granular data on MS expenditure need for an extensive survey at an EU level a common taxonomy of assistive ICT Fine-tune the role of government: consumer oriented, empower the end-user, freedom of choice provision of independent information and advice a common functional list for Europe establish single access points