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New Study Shows Lowering Cost Isn't Enough to Increase Hearing Aid Use


A new study by researchers at Henry Ford Hospital has found adults with mild hearing loss are not motivated by lowered cost to purchase hearing aids.

Virginia Ramachandran, Au.D., Henry Ford Hospital audiologist, and colleagues findings appear in the May issue of The Hearing Journal.

Mild-to-moderate hearing loss is a common problem in older adults. According to NIH Senior Health, approximately 17%, or 36 million, of American adults say that they have some degree of hearing loss. Roughly one-third of Americans 65 to 74 years of age and 47 % of those 75 and older have hearing loss. Men are more likely to experience hearing loss than women.

Even mild-to-moderate hearing loss can cause communication disorders. Most in this group do not pursue the obvious solution: hearing aid amplification. Estimates suggest that as many as 75-80% of adults with hearing sensitivity loss do not acquire hearing aids.

The factors contributing to the lack of hearing aid adoption are thought to be numerous and complex. Many consider their hearing loss and related communication disorder to be too inconsequential to use hearing aids, others have negative attitudes toward hearing aids and the stigma of hearing loss, and still others are confused about how to access hearing healthcare.

Ramachandran and colleagues used their study to explore the role of hearing aid cost in the lack of use of hearing aid devices.

In the United States, with the exception of the Veteran's Administration (VA) system, hearing aid care is generally not covered by government or private insurance programs.

Often, excluding VA fittings, third-party payment for hearing aids accounted for only approximately 30% of hearing aid purchases. Even with recent increases in third-party payment for hearing aids, for most individuals hearing healthcare is an out-of-pocket expense.

The Henry Ford Health System, the largest private insurance provider has two categories of insurance coverage for hearing aids, which allowed Ramachandran and colleagues to examine acquisition behaviors for three groups of patients: full-coverage group, partial-coverage group, and private-pay group.

In the partial-coverage group, patients have a fixed sum of money ($400) to use toward the cost of hearing aids and they pay the remaining cost out of pocket.

In the private-pay group, patients pay the full cost of hearing aids themselves.

A retrospective analysis looked at 1,200 patients, age 51 years or older, who got hearing aids between 2007 and 2010. The degree of hearing loss at the time of hearing aid acquisition was the same for patients in the private-pay (PTA=49) and partial-coverage groups (49), but significantly better in the full-coverage group (44).

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As part of the study, the cost for hearing aids in the partial insurance coverage group was reduced by 20% for two devices or 40% for one device.

The study shows that patients who had full coverage for hearing aids obtained them about seven years earlier and with better hearing than the other two groups. But there was no difference in age or hearing loss between people who paid for the full cost of hearing aids or purchased hearing aids at a substantially reduced cost.

The more patients had to pay out of pocket (partial and private pay groups) the more likely they were to upgrade to a more advanced device. Patients with full coverage were the least likely to upgrade, and only purchased what was fully covered by insurance.

According to the study, the only situation in which patients are motivated to get hearing aids earlier is when they are provided at no cost.

But "free" could come at a higher price to patients' hearing health, says Dr. Ramachandran. "If insurance only fully covers certain hearing aids, patients may miss out on reaping the benefits of more technologically advanced devices or devices better suited to their needs."

Study co-author Brad A. Stach, Ph.D., points out that a lot of people view buying a hearing aid along same line as buying a new refrigerator: It's an expensive item, so even if it's on sale, you won't spend the extra money unless you need it.

"On the other hand, if you need a new refrigerator, you'll shop around to get the best value for the best appliance. It's no different with hearing aids. Most patients will only get them if they feel they need them, regardless of cost, and will often spend a little extra to get the best device," says Dr. Stach, division head of Henry Ford Audiology.

Hearing aids have also greatly advanced in appearance and comfort.

"What people may not realize is that hearing aids now aren't like the ones your grandparents used to wear. Most are small and very easy to wear," says Dr. Ramachandran. "The challenge is changing old perceptions about hearing aids, and showing patients that the benefits far outweigh concerns about appearance and even cost."

Dr. Ramachandran adds that hearing aids can have tremendous benefit for patients with milder degrees of hearing loss.

But the most important thing is that the hearing aids are appropriately fit by an experienced audiologist. Even the best hearing aid on the market won't help if it is not fit properly by an expert.

Reducing Hearing Aid Cost Does Not Influence Device Acquisition for Milder Hearing Loss, But Eliminating it Does; Ramachandran, Virginia AuD; Stach, Brad A. PhD; Becker, Erika; Hearing Journal, May 2011 - Volume 64 - Issue 5 - pp 10,12,14,16-18; doi: 10.1097/01.HJ.0000398146.11002.c9

Henry Ford Hospital, press release, May 10, 2011
NIH Senior Health