The Presidents Council of Advisors on Science and Technology (PCAST) in the USA has taken a look at the hearing aid industry. Their conclusion is that the hearing aid industry has some shortfalls.
Part of their reasoning is the low take up of hearing aids. Indisputably, this is concerning, given our knowledge of the importance of hearing. However, in my opinion, PCAST’s recommendations reflect both the US medical system and the inflated retail price of premium hearing aids.
Quality hearing aids have long been costly. It can be argued that they have been costly to design, but there has also been high profitability at the retail end of the chain. This has encouraged strong vertical integration in the hearing aid industry, and also high return for the investors in retail distribution.
The report doesn’t address a big problem
PCAST have presented their four key recommendations to the White House. All are very pertinent to the debate about “over-the-counter” hearing aids that has been raised over recent years. But the report does not evaluate the underlying “chicken and egg” financial problem of the industry.
Overall, the volume of hearing aids sold is small compared with global need. Thus specialised component prices and manufacturing costs are very high compared with the high volume consumer sector.
For example; my company is able to charge clients low prices because of our business model, and because of our commitment to take away the barriers to getting hearing aids. We supply highly researched, clinically validated technology. Personally, I believe that this is the way to go, rather than supplying amplifier devices that have less potential for high quality hearing outcomes.
Why aren’t all hearing aids priced fairly?
Prices of quality hearing aids won’t drop much below our current prices unless there is a major drop in specialised component prices, which can only happen when there is a major increase in volume. The key question is: are hearing aids medical devices?
The data surrounding the benefits of early uptake of hearing aid use is compelling, yet still people delay. Surely there can be no argument that hearing aids should be priced fairly. Realistically, that doesn’t mean that they should be priced at consumer prices, or that they should be replaced with less sophisticated technology as the PCAST recommends. Why should it be appropriate to sell anything less than good hearing aids that can be supported and personalised?
Instead, government subsidies are needed, and health insurers should rebate more realistically.
The Blamey Saunders pricing solution
Blamey Saunders has a no-gap hearing aid arrangement with HCF because HCF and Blamey Saunders hears have worked together to help HCF clients improve their hearing health. Blamey Saunders has achieved low pricing, partly by cutting out the “middle man”, and working directly with the hearing aid customer. In doing this, we have also empowered our hearing aid users, by letting our clients customise their hearing aids themselves, and by helping them, if they wish, using internet technology. This way we can stay in touch with our customers, and give them professional help with their hearing health.
Most people can take to using hearing aids easily. Some people have trouble, maybe because they have left it so long before getting help, or maybe they have complicated hearing difficulties. Blamey Saunders spots those people and steer them towards a more traditional model of care.
Basic hearing aids are not the right answer to pricing problems
It is wrong to say that people with mild to moderate loss don’t need a customised setting or can use a less sophisticated hearing aid. And that ‘solution’ doesn’t differentiate people who have a mild, but complicated hearing loss. Also, at a time that you remember your hearing, you don’t want to have poor quality sound. You should be going for the best possible sound quality, designed especially for the damaged ear.
Is there a case for self-diagnoses?
The PCAST report makes the proposal that people should be able to self-diagnose, self-treat and self-monitor their hearing condition. The American Academy of Audiology has supported this proposal. I agree, but focus groups run by Blamey Saunders have shown that people prefer to have a “test” for confirmation. This might change with generations who are not brought up to do what the “doctor” orders. Although data (Finnish study) confirms that self-diagnosis is highly specific and selective, this desire for “a test” is likely to be true for same time to come. I have a suspicion that people use the “beep” test to prove to someone that they don’t really have a hearing problem after all! This is the great disservice of people who do a pure tone audiogram and declare that hearing above, say 20dB HL is ok. Clearly nonsense if the person being tested is having trouble hearing, and it’s an incorrect statement based on the wrong test.
However, it might be the answer your client wants to hear. This is completely in keeping with other data (eg Kotchkin) that people believe the expert. So, the idea is good that people can self diagnose, but it’s unlikely to increase hearing aid uptake.
We do need a test, but the right test. An online test that is accessible and compatible with the idea of self-empowerment, but it should be one that investigates hearing for speech at comfortable levels, because that reflects real life and real difficulties. Except for medical investigation purposes, why should we greatly care about the softest sound someone can hear? What we should care about is whether people can hear speech, music and other sounds around them.
Hearing aids need to make sounds to be audible and comfortable. It’s also good as a clinician to know that what you have supplied is effective. The clinically validated Blamey Saunders online speech test can be repeated with hearing aids active, to measure improvement levels.
So are all online tests of equal value? Should there be standards? If so, who gets to make them? Should published data be the criteria? It would be hard in Australia to find a completely independent body to set such criteria.
I find the idea that treatment for hearing loss should be described by degree of Pure Tone Audiogram quite absurd and ill informed.
Hearing loss disability is a function of a number of factors that may not show up based on a category of degree of pure tone loss, which is in any case notoriously difficult to carry out online.
Personal sound amplification products are not the answer
The PCAST’s second recommendation takes on the FDA paper of 2013. This essentially proposes that Personal Sound Amplification Products are acceptable for mild to moderate loss. This is recognised in Australia, where Australian Hearing is promoting a PSAP for early stage hearing loss.
There is a place for direct to client hearing aids, but I don’t see a lot of value for PSAPS. They will predominantly lead to disappointment, though they will adequately help people with conductive hearing loss. My view, is that clients are best served by a mixed channel model, where people who can help themselves do, that doesn’t rely on a pure tone audiogram, and where people can get the degree of help that thy want or need. An over the counter PSAP or an unsupported self fit hearing aid is likely to lead to a lot of client dissatisfaction and goes against modern trends in the move to home based care for chronic conditions.
Audiology faces the same issue as many other tele-health companies, which is that of reimbursement. Clearly in Australia, this is a problem in face to face service too.
The PCAST’s third and fourth recommendation have less relevance as it requires that audiologists provide hearing test results to their client. This is already a requirement in Australia where health records belong to the client. But anecdotal reports are that this information is not always provided freely and gracefully.
Where to from here?
The hearing aid distribution system in Australia is broken, as evidenced by the poor uptake and lack of awareness of the importance of hearing and listening to health. No debate about hearing aid services can be separated from a debate about product and service mix, where the cost of managing a complex client is essentially unable to be reimbursed, outside the Pensioners hearing aid scheme. The PCAST Report pushes this aspect even further into the background.
It’s hard to convey to clients sometimes, that they need professional help, and that the providers of this help like to earn a salary. This is what has led to the sad practice of bundled pricing. We need public education that hearing aids are important, and that rehabilitation is sometimes very important.
It’s my opinion that The President’s Advisory Group have made the situation appear too simple, and doesn’t go deep enough into the issues, other than price, that deter people from acting on hearing loss.