Why Are Digital Hearing Aids So Expensive? 727
sglines writes "Over the last couple of years I've been slowly getting deaf. Too much loud rock and roll I suppose. After flubbing a couple of job interviews because I couldn't understand my inquisitors, I had a hearing test which confirmed what I already knew: I'm deaf. So I tried on a set of behind-the-ear hearing aids. Wow, my keyboard makes clacks as I type and my wife doesn't mumble to herself. Then I asked how much: $3,700 for the pair. Hey, I'm unemployed. The cheapest digital hearing aids they had were $1,200 each. If you look at the specs they are not very impressive. A digital hearing aid has a low-power A-to-D converter. Output consists of D-to-A conversion with volume passing through an equalizer that inversely matches your hearing loss. Most hearing loss, mine included, is frequency dependent, so an equalizer does wonders. The 'cheap' hearing aids had only four channels while the high-end one had twelve. My 1970 amplifier had more than that. I suppose they have some kind of noise reduction circuitry, too, but that's pretty much it. So my question is this: when I can get a very good netbook computer for under $400 why do I need to pay $1,200 per ear for a hearing aid? Alternatives would be welcome."
Use a netbook (Score:2, Interesting)
Grab that netbook, setup ASIO for low latency audio in/out. Grab FFDshow, start a directshow graph which takes audio from the mic & sends it to the speaker. Addin FFDSHOW audio filter in between mic and speaker. Adjust the mixer of ffdshow filter, and possible turn on other noise reducders. Place some earbuds into your ears and ffdshow settings for correct noise levels.
You'll need graph edit for adding filters together. You may also need an external mic boom. And of course you'll have to walk around with a netbook. But it may work? You should probably work on this with a desktop you already own before investing any money of course. And it might not sound as good as the dedicated solution, but maybe you can save some money.
Could possible make an iPhone/iPod app as well.
Alternative (Score:3, Interesting)
If you're actually deaf, and live in a first world country, get yourself registered deaf and tell potential employers about it before you go to interview.
Re:Size (Score:3, Interesting)
My laptop mouse (laser + bluetooth, major brand name) has more processing power than the space shuttle. Retailed for 40 bucks plus shipping. Included is a tiny a Bluetooth transmitter that is 2mm larger than the USB-plug which almost require need a pair of pliers to remove from the USB port, so small is it.
An 64mb mp3-player / USB-stick device plus earbuds can be had for nothing, so the store doesn't have to pay for its disposal.
Hearing aids may be smaller and more complicated than an el-cheapo mp3-player, but I doubt there's more electronic magic going on inside than in a Bluetooth-cordless miniature laser mouse. In comparison with the two devices I mentioned, I would expect the price for hearing aids to be somewhere between 0 and 100 bucks. (dollars, euros)
If they cost 3700 USD, they represent the worth of 100 major brand name Bluetooth laser mice or 500 small mp3-players or 2 quality ULV-based laptops - or 10 iPhones. That is preposterous.
Re:Why? (Score:3, Interesting)
Competition (or the lack thereof) IS a solid bet. But the reasonsfor the lack may be uclear:
1) Government regulation. It cosst a LOT of moey to get ANY medical device approved for sale. This raises barriers to entry and prevents typically cash-starve startups from entering the marketplace.
2) Insurance. By insulating the buyer from the purchase, insurance prevents companies from having to compete on price. Sure, they COULD cut costs, but then they'd make less money per item without increasing sale. Do a GIS for 'price elasticity'.
3) Small market. Yes, there are lots of old, deaf people, but each hearing device lats a long time, so volume is kept low.
4) Liability. If ANYTHING goes wrong with a medical device, no matter how generally effective, losses range from severe to bankrupting! Once a design has been proven safe/effective, there's a strong isincentive to change anything
Result? few options an high prices. Private aircraft fall into similar market forces. Planes aren't much more complicated than go-carts with a laptop computer bolted into the panel but cost orders of magnitude more.
Re:Netbook solution (Score:3, Interesting)
and while you're at it, why not stream everything you hear to storage at home? Drive space is cheap. Hell, run it through voice recognition while you're at it, have a semi-coherent text transcription of the rest of your life
If you're gonna be a cyborg, be a cyborg.
Why not build your own? (Score:3, Interesting)
Chances are your hearing loss is limited to a contiguous range of frequencies. Probably a bell-shaped curve. If such is the case, you could probably design (or get an EE acquaintance to design) a low-cost amplifier with a band-pass filter.
I'm thinking a single 2907 quad op amp could handle the mic input amplification, bandpass filter, and output gain. Connect it to an LM386 400mW audio amp chip, and you're in business. While I'm not affiliated with them, I have used futurlec [futurlec.com] in the past, and they have everything you'd need to build such a circuit yourself. If you want a custom PCB, you can even use the free eagle software to lay it out, and Futurlec can have it printed (in China) for you. Expect about a six-week turnaround.
Re:Netbooks aren't DME (Score:2, Interesting)
Hearing aids tend to be classified as DME (durable medical equipment). Medical equipment has a higher support cost...
My father gets free batteries for life with purchase which is part of the cost. Apparently since his ears had failed to deliver any input to his brain (on SOME but not all wavelengths,) his brain lost patience waiting for the dead frequency info and those brain cells were reassigned. When he got the fancy hearing aids they tested his hearing very carefully and created a map of what he could and could not hear and the hearing aids only amplify those sounds which he struggles with. Shocking!! After years signals started flooding into the brain, the prodigal sound returns! It takes weeks for the brain to retrain itself to process audio info again so every few weeks he has to go in and have his hearing remapped and the EQ adjusted to match his actual hearing which is a big part of the cost, these are far far from plug and play. Lots of tweaking involved which gets steep. Oh but you should have seen the dazzled wide-eyed look he had walking away from the doctors office..."I CAN HEAR HER FLIP-FLOPS!!" and all sorts of such revelations. Also he has some robocop type powers now. He can select directional mic input where he hears what he looks at or even a mic that only hears signals from behind him. As a music lover he is happy as a fly in a pile of poo about these things.
Re:Why? (Score:3, Interesting)
http://www.hearingaidscentral.com/Images/Melody_hearing_aid_Arrow.JPG [hearingaidscentral.com] (-- In the ear
http://static.howstuffworks.com/gif/hearing-aid-4.jpg [howstuffworks.com] -- a tiny one... closer to the shift key on my cellphone.
Re:Medical... (Score:5, Interesting)
"Liability costs!" is the mantra of the medical profession, but it doesn't bear close examination, at least not in this case. There are dozens of medical devices on the market that are not only cheap, but are clearly made without much concern about getting sued. Consider sphygomanometers (love that word!). Most cheap electronic ones are grossly inaccurate — and bad data in this case can literally kill you. (Manual versions are cheap and reasonably accurate, but a pain to use.) Presumably the only legal precaution necessary is a "don't use without medical supervision" label.
It doesn't even bear out in hearing aids. You can get an analog hearing aid for for as little as $200. People like the digital ones because they don't just amplify, they selectively filter to you get the most useful frequencies. I don't know the physics, but I suspect it's far more advanced than a simple equalizer.
One big factor is insurance. In America's weird private-but-not-free-market health care system, anything that's covered by health insurance has a price that's totally disconnected from market economics. A list price isn't what most people pay, it's what the health care providers use as a starting point for negotiation with whoever pays the bills. If you're part of a big risk pool, such as insurance provided by big companies for its employees, the provider only pays a fraction of the full price. As your risk pool gets smaller, you lose negotiating leverage, and the discount shrinks. If you're an individual, you have little or no negotiating leverage, and pay full price, or close to it.
This brings a certain irony to the cries of "socialism!" by those who oppose health care reform. The current system is actually closer to socialized medicine than anything Obama is pushing. Or more precisely, it has the worst disadvantages of a socialist economy: prices set by a bureaucracy, inability to deliver goods and services in a timely manner, and so on. It's why we pay three times per-capita for our health care than the Swiss (not exactly rabid socialists!) for a somewhat inferior product.
leverage the iPhone platform? (Score:2, Interesting)
Perhaps someone could leverage the iPhone platform to develop a hearing aid? Everything required is there... I think. =)
Re:Use a netbook (Score:5, Interesting)
There already is an iPhone/iPod app for this. It's called SoundAMP, and is $10. So for $210 you can get an iPod touch and SoundAMP, and have way more features than a normal hearing aid (unless the new ones can play music, surf the web, etc). It even has a playback feature in case you missed what someone said (presumably in the case where you can't ask them to repeat it, such as TV, or an announcement or something).
Re:Why? (Score:5, Interesting)
Check out a hunting supply catalog, the same device NOT sold as a medical item cost 90% less....
I worked as a nurse for ten years in the geri-psych field. Even my patients with insurance could not always afford the cost of their hearing aids. When the hunting version came out, we bought a couple dozen of them, as a facility, and gave them out as stop gap measures to our patients. It worked. They could hear, and communicate. It's not perfect. I'm a big supporter of it.
Because you live in a greedy shithole of a country (Score:3, Interesting)
Sorry to break it to you.
Might be cheaper to move entirely.
They charge what they can get away with, that's what they can get away with.
Re: form factor (Score:1, Interesting)
nonsense; the web is full of DIY protocols for using silicone molding and similar techniques
It would take a week or two, but I bet it would not be hard to come up iwth a simple process, eg
1) clean ear
2) wipe with release agent (pam)
3) fill ear with soft wax; allow wax to harden
4) remove wax, use as + to create a silicone mold that is a - (eg, take the wax, put it in a box, pour in liquid siliicone, let harden, slice silicone with razor, remove wax
5) put electronics into silicone mould; fill with plastic moulding compound (more silicone or polyurethane,lots of FDA approved items out there
Re:Medical... (Score:4, Interesting)
More than national health care, we need a law saying "a consumer is never required to pay more than 50% over the insurance companies negotiated rates".
With insurance, procedure is $75. ($75 out of my pocket for the first $500 and then "free" to me but $75 on my bill).
Without insurance, procedure is over $1000.
With insurance, pills are $45 a month. (about $1.50)
Without insurance pills are $5.5 *each*.
You can't explain nearly 4x as expensive from economies of scale. The rates for the uninsured are not reasonable.
Re:Medical... (Score:3, Interesting)
Union Rules (Score:3, Interesting)
Re:Medical... (Score:3, Interesting)
Since you typically make microchips one wafer at a time, and the cost to produce a wafer is roughly independent of what's actually on it given a certain production process (ie A masks, B layers, C coatings, etc), your cost per unit goes DOWN for smaller electronics these days.
As other posters have mentioned, the development costs clearly outweigh the manufacturing costs.
Re:Medical... (Score:3, Interesting)
The project is a lot of fun in spite of the FDA
Re:Medical... (Score:3, Interesting)
Yeah, right. And a Jawbone that is retailing for 50$ or so does not have all of that? I mean, really - a Bluetooth headset has more components and more power hungry requirements than the hearing aids and they still are 50$ with 6+ hours of talk time.
How to convert a Jawbone to a hearing aid? Simple: add a equalizer, switch primary mic input with ambient noise reduction mic input, make it always on, turn off Bluetooth.
Re:Medical... (Score:4, Interesting)
This increased transparency would allow consumers to shop around and also would put them in a much stronger position to negotiate (such as offering cash payment up front in exchange for being billed at the same rate as the lowest negotiated rate -- after all, this way the provider doesn't even have to deal with the hassle of billing insurance and fighting with them so such a discount would be very reasonable).
Also, perhaps pass a law that it's illegal for a third party payer (including medicare) to include contract clauses that restrict the provider's ability to set rates for other patients not covered by that third party. Thus, providers would be free to offer whatever deal they wanted to individual consumers.
Re:Medical... (Score:4, Interesting)
As an insured you pay for your own healthcare. You just get a negotiated discount, and the ability to amortize your costs, month to month.
Re:Medical... (Score:3, Interesting)
Well, I've now seen at least one steampunk hearing aid:
http://turonistan.blogspot.com/2009/12/steampunk-hearing-aid.html [blogspot.com]
Re:You get what you pay for (Score:3, Interesting)
The prescription hearing aid is a tax deductable medical expense. Topic 502 - Medical and Dental Expenses
I should have added that you really ought to be making contact with local clinics, vocational rehabilitation services, Social Security, sheltered work programs and other agencies to see what assistance may be available.
Re:You get what you pay for (Score:1, Interesting)
I guess my assumption was that the $1200 was for the device itself, not all the extras. Wouldn't that all be itemized on the bill?
Re:Medical... (Score:3, Interesting)
Re:Medical... (Score:3, Interesting)
Medicare does not negotiate payment rates, it mandates payment rates. Larger states with more House members and those with senators that have been or were in Congress longer have much higher reimbursement rates than other states. It gets pretty bad in states with high amounts of reimbursement per patient, specifically Texas and the Deep South, the performance of this expensive medical care as measured by the mortality rate of Medicare patients is awful. These high costs are due in large part to the excessive reimbursement rates of these areas and the Health Care Bill is supposed to remedy this imbalance, which should be a huge chunk of savings.
http://www.raconline.org/maps/#medicare [raconline.org]
Yeah, the maps are from 2005 and 2006, but Katrina and the other hurricanes probably had few effects in terms of mortality rates in northern Alabama, Oklahoma, and central Louisiana.
Re:Medical... (Score:1, Interesting)
In Denmark, it's free to get hearing aids. :-(
6 years ago, when I got my last pair, they cost the State about $500 apiece (Widex Senso, digital ones).
Usually you'll get new hearing aids every 4 to 5 years (when the warranty runs out).
You can get the hearing aids from the public hospitals (having to wait 3-4 months) or at private hearing clinics (for a fee; however they're not as thorough as the public services. A recent report written by one of my friends did show that the "drawer factor", i.e. percentage of hearing aids ending in a drawer instead of in their users' ears', of privately issued hearing aids was 25% higher than from publicly issued ones).
When my dad's dog ate one of my hearing aids 8 years ago I got some new ones without having to argue at all - but then, I had to wait for a month
So here's another place where I simply don't understand that Americans won't revolt to get a better health care system....