This week’s Hearing International feeds upon a topic that we discussed a couple of weeks ago, the move to over-the-counter (OTC) hearing aids. For some reason those that don’t know the real story, such as Senators Elizabeth Warren and Chuck Grassley and others always feel that the price of hearing aids is too expensive and that is what keeps patients from seeking treatment for their hearing impairment. They look at eyewear being purchased in pharmacies and grocery stores and think that a visual impairment is the same as a hearing impairment, differences which were explained in the previous article. Another issue is that, in the consumer’s mind, hearing aids cost so much more than commercial electronic products, such as iPads, and they should cost relatively the same.
Hearing Aids are Just Commercial Electronics…Why do they Cost so Much?
Politicians, consumers, insurance companies, and others always have a tough time grasping the difference between a highly commercial product that most everyone can use, such as an iPad and a highly customized limited market product such as a hearing aid. Drawing a contrast between an iPad and a hearing aid is like
looking at differences between apples and bananas, but let’s take a look.
Belcher (2014) discusses why a hearing costs 6 times more than an iPad. Belcher’s argument is that while an iPad and a hearing aid have about the same research and development costs, production costs of the iPad are higher but costs to the consumer in the selling of the product are much lower. On the other 
hand, he feels that hearing aids have about the same research and development costs and a lower production cost but a huge cost to sell them bundled up in the retail sales costs.
Here is where Belcher’s argument fades. It fades in that Apple sold 16.2 million iPads in the first quarter of 2016 and hearing aid manufacturers collectively will co not sell that many hearing aids worldwide in a year. There are research and development costs for only one iPad product while hearing aid manufacturers must have an array of products available for various types of hearing losses, so the research and development costs are a greater portion of the overall costs than he estimates.
Another of Belcher’s arguments is that most of the costs of hearing aids are bundled up in the retail costs. While there are a lot of retail sales costs in hearing aids relative to hearing aids, iPads do not need to be fitted to a specific individuals. Here the comparison breaks down again in that selling an iPad to surf the net, email, or other activities is just not nearly the same as working with a patient and new hearing aids to achieve better hearing.
Thus, Belcher’s and other cost comparisons to consumer electronics are totally unrealistic. Manufacturers have very high research and development costs as they must have an innovative device for each hearing loss, lifestyle budget category and to obtain the most benefit from each of these devices they must be fit by a hearing professional that knows the variables of hearing loss and the various hearing aid products. So these comparisons to retail consumer electronics are false.
But……..Are the Cost of Hearing Aids REALLY the Issue??
Consistently, the audiology and hearing literature suggests that it is an average of 5-7 years after those with hearing loss know there is problem and seek hearing care. In the minds of the under informed, this might seem to be caused by the cost of the products. Those of us that have worked with the hearing impaired for decades feel that most of this hesitation to seek treatment is psychological. 
Trychin (2003), a psychologist that has worked for decades with the hearing impaired, presented a classic organization of why people do not seek or put off treatment for hearing loss. Cost was only one of the 20 reasons. While costs were of some concern in his listing, this was before manufacturers and audiologists had various cost levels of products from which to choose and insurance programs that are now available.
Trychin’s list includes the following:
- Don’t Realize They Have a Hearing Loss
- Denial 1: Do not admit they have a hearing loss
- Denial 2: Know they have a hearing loss but don’t think it is a problem for them or others.
- Denial 3: Know they have a hearing loss but do not think there is anything that can be done for it.
- Higher Priorities
- Costs
- Lack of Transportation
- Lack of Motivation to Hear
- Family Resistance
- Fear of being Seen as Failing or Incompetent
- Afraid of Doctors & Professionals
- Motor Coordination Problems
- Bad Prior Experience with Hearing Aids or Vendors
- Friends or Relative Bad Experiences with hearing Aids or Vendors
- Overstimulation
- Emotional Status
- Ear Pain and Allergies
- Vanity
- Fear of Ridicule
Dr. Trychin’s list of reasons why patients do not seek treatment is similar to research results and experience of seasoned professionals. While costs are often used an excuse, the younger mild to moderate hearing impaired individuals and many baby boomers are still working and may have some insurance support for the acquisition of hearing aid products. So, likely, the issue is not the cost of hearing instruments that keeps patients from seeking treatment. Consider European countries where hearing aids are given out for free as part of National Health Insurance programs. Hear-it.org (2017) indicates that in the European Union, where most countries hand out hearing aids for free to their citizens, there are about 55 million individuals with hearing loss. In these countries only 1 in every 6 hearing impaired individuals wear amplification. So the real problem is not costs, it gets back to Trychin’s psychological issues. The age old issue of the stigma of hearing aids.
So….What Will Get More People to use Hearing Aids?
Many of the barriers to hearing aids are being challenged. These challenges are being met by audiology researchers, clinicians, hearing aid manufacturers and others. The methods that are used 
for hearing aid fitting and verification have progressed substantially in the past 10 years. Better hearing aid technology, research into psycho-
acoustical needs of patients, better fitting practices have all contributed to better success in fitting hearing aid products that deliver great benefit.
Manufacturers have taken the some of the stigma that was present 40 years ago and significantly reduced it so that hearing instrument are much more acceptable in 2017 than in past decades. Recall that prior to about 2003 most hearing aids were ear plugs, creating as many problems as they helped. The devices were unsightly and advertised the fact that the patient was old and useless or had diminished capabilities. Engineers and hearing aid manufacturers have made a big dent in the stigma factor by reducing the size, shape, modifying styles of hearing aids. In addition, the culture of having “things in your ears” has become cool in some age groups as well.
Even with these modifications that manufacturers have created, better performance, better fitting techniques by hearing professionals and now the reduction of costs by the use of Personal Sound Amplification Product Systems (PSAPS) and the eventual OTC hearing aids, market penetration will still be the same if there is not much change in the looks of the products. If over the counter hearing aids are presented to the market, there should be on the shelf right next door to them a kit that makes them invisible, such as Vanish which will reduce the sigma substantially.
While hearing devices will cost less, be available at the push of a button on a computer or at the corner drug store, the real market growth will be created by the cosmetics of the products. Hearing aid cosmetics have taken leaps and bounds over the past few years but the products are still visible and a substantial psychological deficit to most personal egos. The going attitude seems to still be, “I can get by, I just do not want to look like I have a hearing loss”. I fear that with reduced costs of hearing aids that we are getting ready for huge pandemic of “Dresser Drawer Syndrome” as the goal is not simply the purchase of these devices, it is wearing of the instruments that is important to better hearing health.
Disclaimer:
Robert Traynor has a financial interest in Vanish.
References:
Belcher, E. (2014). Why does a hearing aid cost 6 X more than an iPad. Audicus. Retrieved March 20, 2017.
Bouton, K., (2013). Why we don’t wear hearing aids. Psychology Today. Retrieve March 20, 2017.
Traynor, RM (2017). Hearing Professionals do it better! Hearing Health and Technology Matters, LLC, Hearing International. March 7, 2017. Retrieved March 21, 2017.
Trychin, S. (2003). Why don’t people that need them get hearing aids. Sam Trychin, Erie, PA. Retrieved March 20, 2017.
Vanish (2017). https://www.hearingaidsvanish.com/ retrieved March 21, 2017.
Images:
Bill the Butcher (2017). Tea Party Tribune. Retrieved March 21, 2017.
