The trend of hearing aid adoption following changes in supply policy in South Korea

This study used nationwide insurance claims data to assess the effect of changes in the hearing aid supply regime on annual trends in the number of newly registered hearing impaired people and the number of subsidies paid for hearing aids. hearing aids. It found that the annual number of newly registered deaf people increased slightly, then decreased during periods of insufficient hearing aid subsidy (2004 to 2014) and increased dramatically in response to a substantial increase in the hearing aid subsidy. auditory (from 2015). Additionally, the proportion of people with newly registered hearing loss who received hearing aid subsidies increased to 85.3% in response to the large increase in hearing aid subsidies in 2015.

To our knowledge, this is the first formal study to assess hearing aid adoption behavior using a national population-based database. The results indicate that a realistic hearing aid provision policy can facilitate rehabilitative behavior in people with hearing loss.

Hearing loss is the most common chronic disease in the elderly. The number of people with hearing loss worldwide is expected to reach 2.45 billion by 2050, a 56.1% increase from 201911. Unaddressed hearing loss and inadequate auditory rehabilitation reduce quality of life in multiple ways, particularly in terms of cognitive function11, and recognition of the social burden of hearing loss has increased. To compensate for the harmful effects associated with deafness and its sequelae, the provision of hearing aids in the audiology clinic is the usual gesture of care.12. Despite the high prevalence of hearing loss among older adults, only a limited proportion of the hearing impaired population who could potentially benefit from a hearing aid report currently using a hearing aid13.14. In the United States, about three-quarters of people with hearing loss cannot afford a hearing aid8. A study of the Korean population showed that only 17.4% of people with moderate to profound bilateral hearing loss purchased a hearing aid, and only about 73% of those people used it regularly.14. The importance of diagnosing and managing hearing loss tends to be underestimated, especially in developing countries11.

The average cost of a pair of fitted hearing aids ranged from $2,200 to $7,000 in 2014, and consumer reports show the average price of a pair of hearing aids was $4,860 in 202115.16. The hearing aid market is controlled by a limited number of companies, and the price of hearing aids is rather high and considered a primary barrier to hearing aid adoption15.17. In other words, insurance coverage is an important driver of hearing aid adoption.18. According to Disability Benefits data, the South Korean government has been subsidizing part of the cost of purchasing hearing aids over 5 years since 1997. The amount of subsidy for hearing aids has increased from 250,000 won (about $200) to 340,000 won (about $300) in 2005 and then tripled to 1,130,000 won (about $1,000) at the end of 2015.

A previous large study in South Korea looked at the 10-year trend in the number of people registered with profound hearing loss from 2006 to 2015.19. It demonstrated that the trend of hearing loss showed a gradual decrease from 2010 to 201519. In the present study, consistent with this report, the number of newly registered people with hearing loss decreased from 2009 to 2013 (Fig. 2A). The decline in the number of newly enrolled deaf people could be explained by assuming that most of those who are motivated by the second level of grant ($300) may well have completed their enrollment within the first 5 years.

However, we found that the number of newly registered deaf people increased sharply from 2015 as the level of the hearing aid subsidy increased. This finding suggests that the price of hearing aids has a major effect on hearing aid adoption in South Korea. Another interesting point is that the previous study may have underestimated the actual number of deaf people, as there were probably many unregistered deaf people before the introduction of a larger hearing aid subsidy. .19. To be registered as hearing impaired in Korea, three pure-tone audiometry tests and a brainstem auditory response test must be taken, and the cost of these hearing tests is around $250 to $300. Since the cost of the assessment approached the subsidy for hearing aids before 2015, people with hearing loss had little incentive to register as hearing impaired. In addition, the real value of the hearing aid subsidy would have declined continuously between 2004 and 2014 if inflation had been taken into account.

The present study also examined the annual trend of severity among newly registered hearing impaired from 2004 to 2018. The frequency of hearing impairment grades 2 and 3, indicating profound hearing loss, among newly registered hearing impaired gradually decreased, while the proportion of individuals with severe hearing loss (grades 4 and 5) increased (Fig. 3). The average age of newly registered deaf people gradually increased from 2004 to 2015 and increased significantly thereafter (Fig. 5), implying that many older deaf people had not registered until 2015. Furthermore, the average time from disability registration to hearing aid adoption decreased sharply (Fig. 6), suggesting that the primary goal of disability registration could usefully be changed to hearing aid adoption. a hearing aid rather than receiving other social benefits for hearing impairment.

This study demonstrated that reducing the cost of hearing aids to consumers/patients by expanding the hearing aid subsidy increased adoption by people with hearing loss who could benefit from a hearing aid. We identified an immediate increase in hearing aid use following the expansion of hearing aid subsidies (Fig. 4). However, there are many other types of barriers to hearing aid adoption besides price.20. In Iceland, the national health insurance scheme fully covers the purchase of hearing aids every 4 years, but only 11% of people with hearing loss use hearing aids21. This low adoption rate of hearing aids is explained by the complexity of the factors underlying the use of hearing aids. Hearing aid adoption is influenced by a complex interplay between personality, perceived social value and social stigma20.22.

Several studies have attempted to quantify the financial outcomes of hearing loss23. A retrospective cohort study in the United States found that the benefit of hearing aid adoption among people reporting hearing loss was identified as reducing the likelihood of emergency department visits and hospitalizations, and decreasing expenditures. of Medicare.17. However, the use of a hearing aid resulted in an increase in office visits, as well as an increase in total health care expenditures and out-of-pocket costs.17. Another study proposed that the provision of hearing aids ultimately adds value to the health care system and provides net savings to the Medicare program.24. After 2015, people with severe to profound hearing loss could receive a hearing aid covering the cost of a single hearing aid under the South Korean national insurance system. It will be important to monitor whether the expansion of the hearing aid provision program reduces the loss of quality of life associated with hearing impairment in terms of access to the medical system and leads to a reduction in overall medical expenditure, and this information should be reflected in any future changes to the provision of hearing aids. Finally, adopting a hearing aid does not necessarily imply regular use of the hearing aid.14.25. Appropriate fitting and checking of hearing aids, as well as counseling are important in establishing an appropriate and effective hearing rehabilitation environment26.

This study has the strength of using nationwide demographic data to investigate annual trends in the number of newly registered hearing impaired people in response to changes in hearing aid provision. He successfully identified changes in hearing aid uptake based on the level of financial support. The study also has limitations, primarily related to the characteristics of the claims data, as it does not include physical examination data such as tympanic membrane status and exact hearing level. Additionally, because the National Hearing Registry System only includes people with severe-to-profound hearing loss, this study could not assess the use of hearing aids by people with hearing loss. mild to moderate hearing loss. These limitations could be overcome in the future by including additional large sources of medical data.

In conclusion, the expansion of the Korean hearing aid delivery program resulted in a dramatic increase in hearing loss registration and hearing aid uptake, indicating that there was a lot of non-hearing loss. recorded or unprocessed before the introduction of realistic hearing aid provision.

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