Analysing and federating the European assistive technology ICT industry Final Report March 2009 Jennifer Stack Leire Zarate Carmen Pastor ROBOTIKER-TECNALIA Niels-Erik Mathiassen The Association for the Advancement of Assistive Technology In Europe AAATE Ricard Barberà Institut De Biomecànica De València IBV Harry Knops Hugo Kornsten Next Generation For All NG4ALL The opinions expressed in this document are those of the authors and do not necessarily reflect the views of the European Commission TABLE OF CONTENTS 1. EXECUTIVE SUMMARY 6 2. INTRODUCTION 9 3. METHODOLOGY 10 3.1. INTRODUCTION 10 3.2. SELECTION OF 5 KEY AT ICT PRODUCT GROUPS 10 3.2.1. Hearing aids 11 3.2.2. Braille displays 11 3.2.3. Environmental control systems 11 3.2.4. Software 12 3.2.5. Communication devices 12 3.3. PART I – INFORMATION GATHERING 13 3.3.1. Database analysis 13 3.3.2. Desk research 13 3.3.3. Industry events 14 3.3.4. Company interviews 14 3.3.5. AAATE National Contact Points Questionnaire 15 3.4. PART II – HYPOTHESES TESTING 15 3.4.1. Telephone interviews with companies 16 3.4.2. Workshop at ICCHP 2008 17 3.4.3. Questionnaire for industry 17 3.4.4. International comparison 19 4. GENERAL CHARACTERISATION OF THE AT ICT INDUSTRY 20 4.1. DEFINITION OF AT ICT ASSISTIVE PRODUCTS 20 4.2. SYSTEMATISATION OF THE AT ICT INDUSTRY 20 4.2.1. PRODUCTS – What is included in the AT ICT industry 21 4.2.1.1. ISO classification 22 4.2.2. PROCESSES – How the AT ICT industry functions 23 4.2.2.1. EUROPEAN UNION 24 4.2.2.1.1. Analysis of the AT ICT value chain 24 4.2.2.1.1.1. Research & development 24 4.2.2.1.1.2. Production 26 4.2.2.1.1.3. Distribution & retail 26 4.2.2.1.1.4. Service delivery 28 4.2.2.2. United states 37 4.2.2.2.1. Service Delivery Systems 37 4.2.2.2.1.1. Medicare 38 4.2.2.2.1.2. Medicaid 39 4.2.2.2.1.3. Veterans Administration 40 4.2.2.2.2. Spending on Assistive Technology 40 4.2.2.3. JAPAN 41 4.2.2.4. SUMMARY OBSERVATIONS ON THE TYPES OF PROCESSES USED IN THE AT ICT INDUSTRY IN EUROPE, THE UNITED STATES AND JAPAN 42 4.2.3. ACTORS – Who participates in the EU AT ICT industry 43 4.2.4. ORGANISATIONS – How the actors are organised 43 4.2.4.1. EUROPE 43 4.2.4.1.1. Governmental and legal organisations 44 4.2.4.1.2. Information service and training organisations 47 4.2.4.1.3. Financing organisations 48 4.2.4.1.4. Technology oriented organisations 49 4.2.4.1.5. Professional and end-user organisations 50 4.2.4.1.6. AT ICT industry organisations 51 4.2.4.2. UNITED STATES 53 4.2.4.2.1. Research and Development organisations 53 4.2.4.2.1.1. NIDDR 53 4.2.4.2.1.2. ACCESS-BOARD 55 4.2.4.2.1.3. ANSI & NIST 55 4.2.4.2.2. industry organisations 56 4.2.4.2.2.1. ATIA 56 4.2.4.2.2.2. RESNA 57 4.2.4.2.2.3. ATA 58 4.2.4.2.2.4. ATAP 59 4.2.4.2.2.5. AFB 60 4.2.4.3. JAPAN 61 4.2.4.3.1. Research and Development organisations 61 4.2.4.3.1.1. REHAB 61 4.2.4.3.1.2. NISE 62 4.2.4.3.2. Industry Organisations 63 4.2.4.3.2.1. RESJA 63 4.2.4.3.2.2. ADF 64 4.2.4.3.2.3. JSRPD 65 4.2.4.4. SUMMARY OBSERVATIONS ON THE LEVEL OF ORGANISATION IN THE AT ICT INDUSTRY IN EUROPE, THE UNITED STATES AND JAPAN 65 5. DESCRIPTION OF THE FIVE PRODUCT GROUPS 66 5.1. HEARING AIDS 66 5.1.1. MARKET PLAYERS 66 5.1.2. MARKET SIZE 71 5.1.3. BARRIERS TO ENTRY 73 5.1.4. CLIENTS 73 5.1.5. DISTRIBUTION 74 5.1.6. FINANCING 74 5.1.7. INNOVATION 74 5.1.7.1. Product development 74 5.1.7.2. Licensing of hearing aid technology 75 5.1.7.3. CONCLUSIONS 76 5.2. BRAILLE READERS 76 5.2.1. TYPOLOGY OF COMPANIES/MARKET 77 5.2.2. COMPETITION 78 5.2.3. DISTRIBUTION 79 5.2.4. FINANCING 79 5.2.5. INNOVATION 79 5.2.6. CONCLUSIONS 79 5.3. ENVIRONMENTAL CONTROL SYSTEMS 80 5.3.1. COMPETITION 80 5.3.2. DISTRIBUTION 82 5.3.3. FINANCING 82 5.3.4. INNOVATION / R&D 83 5.3.5. CONCLUSIONS 83 5.4. SOFTWARE 83 5.4.1. PRODUCT CLASSIFICATION 84 5.4.2. FIRMS IN THE AT SOFTWARE MARKET 85 5.4.3. COMPETITION 87 5.4.4. DISTRIBUTION 87 5.4.5. FINANCING 87 5.4.6. CONCLUSIONS 88 5.5. COMMUNICATIONS DEVICES 88 5.5.1. DISTRIBUTION 90 5.5.2. FINANCING 90 6. IDENTIFICATION OF THE COMMON NEEDS OF THE INDUSTRY 91 7. STRATEGIC ASPECTS 95 7.1. EU AT ICT INDUSTRY DRIVERS 95 7.2. EU AT ICT INDUSTRY BARRIERS 97 7.3. AN ANALYSIS OF THE AT ICT INDUSTRY USING PORTER’S 5 FORCES MODEL 99 7.3.1. Buyer power 100 7.3.2. Suppliers 101 7.3.3. Substitutes 102 7.3.4. New entrants 103 7.3.5. Industry rivalry – How does the industry compete? 104 7.4. CONSIDERATION OF THE AT INDUSTRIES IN THE U.S. AND JAPAN 106 7.5. ANSOFF GROWTH MATRIX 108 7.5.1. Very large company in the Hearing Instrument Segment 110 7.5.2. Large Company in the Braille Reader segment 111 7.5.3. Large company in the Environmental Control Systems Segment 111 7.5.4. Small company in the Software Segment 111 7.5.5. Small company in the Communication devices Segment 111 7.6. AT ICT INDUSTRY CONSOLIDATION VIA MERGERS AND ACQUISITIONS 112 8. CHALLENGES AND CHANGES AFFECTING THE AT ICT INDUSTRY IN EUROPE 114 8.1. STANDARDISATION, MAINSTREAMING AND DESIGN FOR ALL 114 8.1.1. EUROPE 114 8.1.1.1. Standardisation 114 8.1.1.2. Design for All and Mainstreaming 115 8.1.2. SITUATION IN THE United stateS 118 8.1.3. SITUATION IN JAPAN 119 8.2. GREATER AWARENESS OF AT PRODUCT OFFERINGS 122 8.3. AGING POPULATION & RELATED COST PRESSURES 123 9. ROLE OF POLICY MAKERS 127 9.1. EUROPEAN UNION 127 9.2. UNITED STATES AND JAPAN 128 9.3. SUMMARY COMPARISON 130 10. THE BEST ALTERNATIVE FOR STRUCTURING THE AT ICT INDUSTRY IN EUROPE 131 10.1. OPERATIONAL ISSUES 134 11. RECOMMENDATIONS AND CONCLUSIONS 135 11.1. RECOMMENDATION FOR AN AT ICT ORGANISATION 135 11.2. ADVANTAGES AND DISADVANTAGES 136 11.2.1. ADVANTAGES 136 11.2.2. DISADVANTAGES 137 11.3. CONCLUSIONS 138 12. ANNEXES 140 12.1. DETAILED DESCRIPTION OF AT ICT PRODUCTS ACCORDING TO THE ISO 9999:2007 CLASSIFICATION SYSTEM 140 12.1.1. Asssistive products for seeing 140 12.1.2. Assistive products for hearing 141 12.1.3. Assistive products for voice production 141 12.1.4. Assistive products for drawing and writing 142 12.1.5. Assistive products for calculation 142 12.1.6. Assistive products for handling audio, visual and video information 143 12.1.7. Assistive products for face-to-face communication 143 12.1.8. Assistive products for telephoning (and telematic messaging) 144 12.1.9. Assistive products for alarming, indicating and signalling 144 12.1.10. Assistive products for reading 145 12.1.11. Computers and terminals 146 12.1.12. Input devices for computers 146 12.1.13. Output devices for computers 146 12.2. QUESTIONNAIRE COMPLETED BY AAATE NCPS 148 12.3. QUESTIONNAIRE USED FOR TELEPHONE INTERVIEWS WITH EUROPEAN AT ICT COMPANIES 150 12.4. LIST OF ORGANISATIONS KEY TO THE ICT INDUSTRY IN EUROPE 151 12.4.1. Governmental and legal organisations 151 12.4.2. Information service and training organisations 152 12.4.3. Technology oriented organisations 154 12.4.4. Financing organisations 155 12.4.5. Professional and end-user organisations 155 12.4.6. AT ICT Industry organisations 157 12.5. COUNTRY SPECIFIC INFORMATION RECEIVED BY AAATE NCPS QUESTIONNAIRE 158 12.5.1. Reimbursement Policies (I) 158 12.5.2. Reimbursement Policies (II) 159 12.5.3. Reimbursement Policies (III) 160 12.5.4. Regulatory entities (I) 161 12.5.5. Regulatory entities (II) 162 12.5.6. Regulatory entities (III) 163 12.6. VALIDATION QUESTIONNAIRE COMPLETED BY EUROPEAN AT ICT COMPANIES 164 12.7. SELECTED RESULTS FROM INTERVIEWS WITH EUROPEAN AT ICT COMPANIES 165 12.8. MAIN AT ICT EVENTS 166 12.9. TABLE OF COMPANIES: EASTIN & HANDICAT 168 12.9.1. National Data Bases with information as to available AT products 170 12.9.2. TABLE OF COMPANIES: EASTIN & HANDICAT 172 1. EXECUTIVE SUMMARY There are currently approximately 45 million people in Europe who report a long standing health problem or disability1. Further, the aging population means that more people will have to live with some sort of disability. Recent figures from the 2008-based national population projections EUROPOP20082 show that the share of people aged 65 years or over in the total population is projected to increase from 17.1% to 30.0% and the number is projected to rise from 84.6 million in 2008 to 151.5 million in 2060.