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Comments: 727 + - Ask Slashdot: Why Are Digital Hearing Aids So Expensive? on Saturday March 13, @03:30PM
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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."
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Why? (Score:5, Insightful)
Medical... (Score:5, Insightful)
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Re:Medical... (Score:5, Insightful)
and regulation/licensing on medical devices.
That's a really expensive one.
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Re:Medical... (Score:4, Insightful)
Also people are always going to be paying for it with insurance, so the price doesn't actually hit consumers. There's no reason for a consumer to buy a cheaper hearing aid, so prices inflate.
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Re:Medical... (Score:5, Insightful)
With the info floating around during this whole US health care debate, I would agree to the above point:
If you try to do anything medical or get any medical device in the USA you would be charged 10-50 times more than it actually costs. The prices are grossly inflated and then the big insurance companies negotiate them down by 90% or so. This is mostly in make sure that you don't go and get healthcare on your own. It also serves as a good way to keep some new insurance company from springing up - if you are not big enough, you can't negotiate such a discount, so you can't be profitable.
The insurance companies are all in a cartel. It would be illegal for any other business, but health insurance companies have a special exception.
There is no free market in health insurance in the USA and there has never been one, so there is no competition. Thus all the prices and profit margins are simply decided at the cartel meeting without any regard to real cost or social benefit.
My advice - go to a country with a real healthcare somewhere in EU or Canada or Asia and get some hearing aids there. It will come out cheaper even with a plane ticket.
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Re:Medical... (Score:5, Informative)
My very unscientific research suggests that hearing aids cost around £3,000 (approx $4,500) in Britain.
Source: http://www.rnid.org.uk/community/forums/products/hidden_hearing/ [rnid.org.uk]
In Europe, Hungary may be cheaper. A lot of health tourists go there.
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Re:Medical... (Score:5, Informative)
the big insurance companies negotiate them down by 90% or so. This is mostly in make sure that you don't go and get healthcare on your own. It also serves as a good way to keep some new insurance company from springing up - if you are not big enough, you can't negotiate such a discount, so you can't be profitable.
The insurance companies are all in a cartel. It would be illegal for any other business, but health insurance companies have a special exception.
There is no free market in health insurance in the USA and there has never been one, so there is no competition. Thus all the prices and profit margins are simply decided at the cartel meeting without any regard to real cost or social benefit.
Over the last couple of years I've been slowly getting paranoid. Too much reading slashdot I suppose. After flubbing a couple of job interviews because I scared my inquisitors, I had a psychology test which confirmed what I already knew: I'm prone to fits of fancy, bits of balderdash, and countless conspiracies. So I tried on a tin foil hat. Wow, my neighbors harvest organs and my wife mumbles ancient sandskrit curses to herself. Then I asked how much: $3,700. Hey, I'm unemployed. The cheapest tinfoil hat they had were $1,200 each.
I'm actually not unemployed. I work for an insurance company. Not only that, I work for a non-profit insurance company. They operate in four states as Blue Cross and Blue Shield (BCBS) plans. I've been on the host and home side which means that I have priced claims per contract with the rendering physicians (Host) and I have paid claims based on the contract that an employer has drawn up with the insurance company for their employees (Home).
Often enough lab tests (80000 cpt codes) are reduced fairly significantly in what we call in network pricing. A provider who is in network signs a contract accepting our pricing structure and in return is promoted as a BCBS provider which provides them with more patients. I've processed many a hearing aid and they do not get a significant reduction. Because of this there are exclusions that limit you to one hearing aid every three years.
I'm not sure what you're requirements are but http://www.hearaidstore.com/ [hearaidstore.com] appears to have cheaper models.
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Re:Sounds like someone who's never traveled (Score:5, Insightful)
I'd rather pay double for eyeglasses and hearing aids than go bankrupt because I fell ill.
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Re:Medical... (Score:5, Insightful)
I have a relative in the business. They license the popular brand name like a franchise and make obscene amounts of profit. As their single store in a strip mall with no real traffic pulls in enough for two houses and twice as many cars for the husband and wife.
They have to manage stock of some units but the majority are ordered, the overhead is the employees and some testing equipment.
The margin for profit is ridiculous.
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Re:Medical... (Score:5, Insightful)
Otherwise I'm sure we would of all seen at least a few steam punk hearing aid mods by now.
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Re:Medical... (Score:4, Insightful)
Which is kind of insane thinking about it, a hearing aid is different from a heart stint with magnitudes order different levels of risk.
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Re:Medical... (Score:5, Informative)
Which is kind of insane thinking about it, a hearing aid is different from a heart stint with magnitudes order different levels of risk.
...Which is why hearing instruments are class I medical devices and stents are class III. A basic synopsis here: http://en.wikipedia.org/wiki/Medical_device#Class_I:_General_Controls [wikipedia.org]
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Re:Medical... (Score:5, Insightful)
It is a medical device which means that it is subject to insane levels of litigation. Mostly you are probably paying for insurance.
It is a medical device which means that it is subject to insane markups. Mostly they are probably paid for by insurance, so there is little attention paid to cost by consumers.
There, I fixed that for you.
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Re:Medical... (Score:5, Insightful)
Mostly they are probably paid for by insurance, so there is little attention paid to cost by consumers.
In the case of hearing aids this isn't all that true. The people who most commonly need hearing aids are older, and likely to be retired. Many of then are NOT covered by insurance. But if you're powerful, or were sufficiently powerful, you ARE likely to have a health insurance that covers it. So there's no push to correct this among the people who have the power to cause it to be corrected.
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Re:Medical... (Score:4, Insightful)
I've seen this also. Insurance companies used to help people when they were in need, but then the shareholders noticed that they could make much more money if they just sell insurance and not help the people. So nowadays they simply cover only the cheap or very rare things and the rest you have to pay yourself. It doesn't make sense anymore to buy insurance.
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Re:Medical... (Score:5, Informative)
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Re:Medical... (Score:5, Informative)
Yes, those insurance companies need to maintain their awesome 3-4% profit margin. Disconnect the consumer purchase decision from the product pricing and pricing becomes irrational.
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Re:Medical... (Score:5, Insightful)
Also, try to pack all that electronics into such a small package, including feedback cancellation (that really loud whine that older hearing aids were prone to produce) and and it has to be able to run on a single battery for at least a few hours at a time.
Add doctors fees for fitting, set-up and production of the ear piece which is (supposedly) moulded to fit your ear perfectly.
Headkase and Gription have good points as well. It all adds up.
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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.
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Re:Medical... (Score:5, Informative)
This has always been my wondering too... The hearing aid just contains a tiny amplifier that is mass produced along with a tiny microphone. The only part that is unique is the ear plug part that are form fitted to your uniquely shaped ear so as to stop the escape of sound which can contribute to annoying feedback.
I lost my hearing during the 60's from the rifles and pistols going off near my ears. So I have learned to cope best I can for nearly my whole adult lifetime with a combination of lip reading and hearing only partially. Compared with many of my brothers and sister who returned greatly scarred or died during their service then i count myself lucky in comparison and try never to complain.
In my case the loud violent sounds did not kill the nerves, rather it hardened the stapes (stirrup) so it would not transmit the vibrations from the anvil to the choclea so a #40 wire was inserted but it has a great Db loss so I am forced to wear hearing aids when I am out.
Surprisingly enough, the nerves (cochlea) of mine is more sensitive than most individuals and for me it is like wearing ear plugs all of the time thus reducing the volume of what i hear. The nerves are tested by bone conduction in transmitting the sound on the skull and measuring the point at which the sound can no longer be heard... typically there is a 5 to 10 Db loss from the sound having to penetrate the skull.
One of my hearing aids went out and I picked it up yesterday from repair and the fee was $325 to replace the amplifier in it. Another form of ripoff during the repair cycle.
I am mostly retired now and insurance nor social security does not cover these costs. I did like the parent poster and checked the cost of new hearing aids but the price was so high that the repair (with 6 month warranty) was the only reasonable solution.
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Re:Why? (Score:5, Insightful)
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Re:Why? (Score:4)
A hunter's ear thing won't be tuned to the particular loss, it amplifies everything.
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Re:Why? (Score:4, Insightful)
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You get what you pay for (Score:5, Informative)
Check out a hunting supply catalog, the same device NOT sold as a medical item cost 90% less....
You pay for the exam.
You pay for the hearing aid.
But you are also paying for the licensed technician who helps you chose the right hearing aid. Casts the earpiece for a proper fit. Adjusts the settings to properly compensate for your hearing loss.
Provides follow-up support and service.
You pay for the record-keeping.
Should something go disastrously wrong on the job, you just might be asked who installed your hearing aid.
The prescription hearing aid is a tax deductable medical expense. Topic 502 - Medical and Dental Expenses [irs.gov]
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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.
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Re:Why? (Score:5, Informative)
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Re:Why? (Score:5, Insightful)
I was going to go with: "because they're so freaking tiny." For some reason, submitter is assuming that its somehow easy to cram all of the necessary technology into a package the size of your Shift key and still have room for a battery. Add to it the fact that this isn't a mass-market product and also that it's technically a medical device so the price is easily tripled after the development and manufacturing costs are figured in.
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Size (Score:5, Insightful)
It's not complicated, hearing aids need to be very small. Neither your 1970's amp nor your netbook will fit in your ear. Making something small and reliable enough for this kind of use is difficult and expensive.
Re:Size (Score:5, Funny)
"Neither your 1970's amp nor your netbook will fit in your ear."
That's a little presumptuous. Have you actually SEEN his ear?
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Re:Size (Score:5, Informative)
So my mini BTE ears (Rexton Cobalts) are about the size of a pinto bean, feature wireless bluetooth audio, house a battery that lasts for a week at 14 hours per day, is made to withstand being in a moist environment 14 hours per day for about 5 years, has a speaker that can generate crystal clear audio from about 400Hz to about 5kHz, amplified about 90dB (yeah, I am basically stone deaf), and the speaker is about the size of the tip of a pen. It has enough DSP power to dwarf a laptop from 10 years ago.
Really, someone's surprised that these things cost a lot? Yes, the markup is unbelievable, but these are not your grandfather's hearing aids.
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$400 Laptop (Score:5, Insightful)
Well, if you have software on your $400 laptop that can do the digital to analog / analog to digital just like you say, the solution is clear: hold one laptop up to each ear.
That's still going to be $800, but that's a lil' cheaper than the $1200 pair you were looking at.
Re:$400 Laptop (Score:4, Funny)
That's just silly. Holding them up, really, is that the best you can come up with? It's obvious that they should be suspended as earrings.
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I am in the same boat too with these things (Score:5, Insightful)
I too have to wear one and it's ungodly expensive. My argument is the fact I need them to have a normal life and work. So if people can get glasses for fairly low price and it's a item that people need then why can't insurance companies provide coverage too? Reason for that it's very specialized market and expensive.
Don't get one of those cheapie $49.95 hearing aids from the ads as they do not provide the proper specs to the type of hearing loss you have. In fact it'll make your hearing worse. It'll be like listening to iPod all day long.
See if they can offer a payment plan.
Good luck.
Voc Rehab (Score:5, Informative)
Netbooks aren't DME (Score:5, Informative)
On a recent flight, I heard an older man talk to the woman he was sitting next to about this same issue.
Hearing aids tend to be classified as DME (durable medical equipment). Medical equipment has a higher support cost than netbooks, and the insurance companies are happy to pay. The cost of entry in the DME market is much higher the netbook market.
Although there is a huge market for the product, the liabilities involved in selling these products significantly raises the risk, and therefore the price, in such products.
Hearing Aids are usually custom made (Score:5, Informative)
Decent ones that your wear all the time are typically molded to the inside of your ear and hand-adjusted. This means a real person has to touch them and they can't be mass-manufactured, similar to dental devices like crowns and such (which are comparable in cost).
Re:Hearing Aids are usually custom made (Score:5, Informative)
No. The earmold is purchased separately from the hearing aid and attached via a plastic tube. You can buy earmolds for well under $100, and there is actually a market outside of hearing aids for them, such as high-end stereo headphones and monitor headphones worn by musicians. The earmold is attached to the aid with a $1.00 plastic tube, which you usually change every 3 months or so. The aid is programmed by plugging it into a computer (the interface is usually via the battery door). The aid itself can easily be mass-manufactured, since once size does fit all.
Parent
uhh (Score:4, Funny)
Why Are Digital Hearing Aids So Expensive?
What???
Not to make fun of you (Score:5, Insightful)
But this is why it's important to wear ear protection for such seemingly innocuous tasks such as mowing the lawn (or any loud task, really). So many kids back then and still these days listening to their personal music players via headphones where you can hear the music from across the street. It's just stupid and a few $ of protection today will save you $$$ in the long run.
I have relatives going deaf with age, watching TV with them is not fun. TV volumes set at a level wear I have to wear ear protection.
Re:Not to make fun of you (Score:4, Insightful)
It's a just revenge on the fucking idiots with thumpy car stereos, I tell you.
Parent
It's a medical device, not a consumer item! (Score:5, Insightful)
There are less expensive alternatives (Score:5, Informative)
There is the songbird [songbirdhearing.com] brand of hearing aids that are far less than a traditional hearing aid. The disposable (400 hours of use) is $80 USD plus shipping. The permanent one is $280.
Secondly, I might would consider a pocket type [activeforever.com] hearing amplifier with a traditional earphone. It may save on expensive batteries and be easier on the ear physically.
The higher cost of hearing aids came from the miniaturization, and the price has stayed high. However, with surface mount components now readily available, I expect that there will be more competition in this space.
I commend you for taking care of this. I have a family member that refuses to admit to his hearing loss, and it truly can be a miserable experience being around him because he takes offense at things that people did not really say, but that he misheared.
Also, you are in my thoughts/prayers during this time of unemployment struggle for many of us.
Lots of people have speculated reasons (Score:5, Informative)
And, I hate to say it but I rather think lots of people are wrong.
The few who have basically said "because they can get away with it" - congratulations.
From the tone of your post (mentioning prices in $), I'm assuming you're in the US. Which is a bit of a shame because these people [hearingdirect.com] have just opened up with a view to putting the proverbial cat among the pigeons. Maybe you know someone in the UK who can post a hearing aid on to you?
Prices are actually falling fast (Score:5, Informative)
Any medium size company can obtain an A/D, a D/A and a DSP and glue them together. Now add a microphone 4mm long by 2mm diameter that handles the frequency range 125-8000Hz, a speaker the same size that handles the same range with high power levels, and then run the whole thing off a tiny battery for a week of continuous use.
What people who compare these things to MP3 players and the like do not understand is this. Deaf people need a much higher in-ear volume than people with normal hearing. Furthermore, they usually suffer from selective hearing loss. This means that certain frequencies have to be output at levels just below that at which damage could occur. The sound quality and volume needed from a hearing aid reproduction chain is very much greater than that for an iPod or similar.
Nor is that all. It is not just selective amplification. Modern hearing aids can do tricks like identify refrigerator hum or hard drive noise and selectively reduce it so that the user can better distinguish other sounds. I had direct experience of this once in a meeting that took place in a room next to a large running Heidelberg printing press. I could distinguish other speakers because of the noise reduction, but the other participants could not and the meeting was abandoned. By switching between "music" and "speech" modes I could easily hear the difference.
In fact there is now a lot of competition in the hearing aid market with a number of new entrants, and as volumes increase prices are falling. But they are not easy toys to make. Small size, physical robustness, extremely low power consumption, high output, advanced digital signal processing and relatively low volume production means that $1800 is not really much to pay.
That's not how hearing aids work... (Score:5, Informative)
Most hearing aids don't amplify (well, not as their primary purpose anyway) anymore. Back in the old days, sure, that's what they did (electronic equivalent of an ear horn).
Modern hearing aids shift frequencies (usually downward, high frequencies have the most energy so you damage the short hairs in your cochlea first) to a frequency range you *can* still hear.
So if you're thinking about making your own, *please* do the proper research first. It will work better, and you will be less likely to damage your hearing further.
Worn hearing aids since elementary school... (Score:5, Informative)
You can probably forget about insurance covering it. Almost no health insurance will cover them. They're considered non-essential, "cosmetic" devices. My company provides very good health insurance and only once over the past 30 years have they ever covered -any- of my hearing aid purchases. 11 years ago (during the dot.com boom) I actually had a company cover part of one ( $1000 of a $2800 purchase ) but that was an anomaly. If you're lucky they might cover the hearing exam but considering most places give you that free as part of the purchase process it doesn't do much good. I've had a couple insurance companies tell me "no we don't cover them, but we offer these great coupons" which were basically a 25% discount off of something that was marked up 100% to begin with.
The most important thing I can tell you is to get a Costco, Sam's Club, or other shopping club membership. I have a Costco membership and have bought my last two sets of hearing aids there. They were 1/3 the price that I was charged at regular hearing aid stores. Costco had audiologists that were just as qualified as the regular stores, and sold the same models/manufacturers as the regular stores. As an example, my last "hearing aid store" model cost $2800 in 1999. The three I've bought since then ( the last two a couple of years ago ) cost $890-$1000 each and were far better than the $2800 model.
Factors in the hearing aid equation. (Score:5, Informative)
There are a number of things commenters here seem not to know about the hearing aid racket. I have a profound hearing loss and have been wearing hearing aids for most of a decade now, let me fill you in on just a few of the things I have learned.
For all of you championing some sort of cheap or build it yourself aid - unless you have a very light hearing loss, forget that. I once thought the same thing, and tried a number of them, and found that they're basically crap. Just amplifying all sound that hits the microphone doesn't work well at all. A door slamming or a dish clinking can be VERY PAINFUL if overamplified, even if a person without hearing loss barely notices them. After this consideration, there's the problem of the sounds you want to hear being buried under a bunch of sounds that are present but not bothersome in daily life: cars driving by, computer and HVAC fans running, refrigerators humming, crowd noises, air and hair moving over the microphones, and so on.
I'm not an audiologist or in any way connected to the industry other than as a customer, but what I've learned over the years from wearing high- and low-end hearing aids (I have one pair that cost almost $7000) is, human hearing is far more complex than most people realize. Most folks out there swim in a sea of sound that they are well attuned to, but like a fish, give little thought to the navigation of. It just works, like magic. When your hearing starts breaking down, though, it's an incredibly hard problem to selectively amplify the sounds you want to hear in the many situations you will encounter throughout the day. In a crowded room you want to 'focus' your ears on the person in front of you; in the kitchen you want to be able to hear several people who may be moving around as they speak yet filter out extraneous noise like the bacon frying in the pan, the refrigerator hum, the fan over the stove, the dishes rattling around. A healthy ear does all this effortlessly; hearing aids are only now getting enough processing power to do it maybe half as well.
I cannot stress this enough, by the way. NO hearing aid will bring your hearing back to what it was. At their BEST, hearing aids are about as good as a cheap car radio tuning a weak station. If you don't need hearing aids now, protect your hearing, because losing it sucks in about a jillion ways.
In the US, most insurance plans do NOT cover hearing aids. The VA does, and they are the number one hearing aid dispenser in the country. Costco is #2 and they don't even bother handling insurance claims for the patient - he will have to do the insurance paperwork on his own. (I know; I'm wearing a new $3k pair of Costco aids right now and am lucky to be one of the few in my area with a plan that covers part of the cost.)
Many if not most states have laws which require the hearing aid dispenser to take back the aids and provide a full refund with no questions asked within 30-60 days of first receiving them. And when that happens, that set of aids can't be re-sold unless (at minimum) they go back to the factory to be completely rebuilt. This creates a number of people who will comparison shop by wearing multiple aids for most of the trial period, then returning them. In their defense, that's about the only way to know if a hearing aid and audiologist/fitter work well for a person. But even so, this creates a lot of wasted time and investment for audiologists and fitters. They have to make up the loss somehow.
Usually the price of the hearing aids includes months or years of followup visits to the audiologist or fitter. And if you wear hearing aids, you'll need them. Everyone has a different hearing loss and everyone has a different set of situations they need to hear well in. So the audie/fitter will need to make a number of adjustments during the lifetime of your hearing aids. Additionally the aids are subject to a lot of moisture and earwax (your ear canal is actually a pretty disgusting place) so the audie/fitter will have to clean and recondition the aids more often
Re:Why? Let me count the ways... (Score:4, Insightful)
So you heard it everyone. Geekmux has issues a challenge!
First someone start a wiki to organize the project.
Someone make the hardware specs. Some A/D, D/A converters, some processing. Someone write the software. How small can an Arduino be made? Someone contact Bre Pettis about cheap fabbing of the housing body.
It doesn't have to be commercially viable. It just has to work and be easy enough to make that the local hackerspace can make them for their friends and loved ones. The threat of competition alone will drive down prices enormously. Don't worry about patents and trademarks. We aren't going to be selling these, we're going to give the plans out FREE in so many places any hacker can make one.
This is the new world Cory Doctorow has been writing about.
GO!
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Re:Alternative (Score:5, Insightful)
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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).
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