Affordability and Willingness to Pay: Applications of Healthcare Economics in Audiology

• Main Author: Jilla, Anna Marie
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2019
• Subjects: Audiology; Health care management; Public health
• ISBN: 9781085632447; 108563244X

Background Information Hearing aids are the most common treatment for sensorineural hearing loss (SNHL) but are seldom covered by insurance policies and cost over $4,500 on average for a pair. Untreated hearing loss gives rise to negative health consequences and has been associated with other chronic health concerns such as dementia. Yet, only one in every three persons with hearing loss obtains hearing aids. Cost is a commonly cited barrier to accessibility of hearing health care (HHC). The present study sought to assess ability and willingness to pay (WTP) for hearing aids and related services using health economics approaches. Methods The catastrophic and impoverishment health economic analyses were applied to the United States Census Bureau American Community Survey for individuals who responded to questions about income and self-reported serious hearing difficulty (SRSHD) yielding 2,348,374 for the overall sample and 120,286 for those with SRSHD. The catastrophic approach determined the percentage of the sample for which a hearing aid price would exceed a given proportion of income (e.g., 3%); the impoverishment approach calculated what percentage of the sample that would fall below the United States (US) Federal Poverty Level (FPL) for the year as a result of hearing aid purchase. Affordability issues were also assessed in relation to demographic characteristics such as SRSHD, race, age, gender, geographic location, and educational attainment. Cost-benefit analyses (CBAs) were applied using a WTP approach to measure perceived economic value of advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing aids, and associated hearing aid services. Postal surveys were sent to 500 randomly-selected experienced amplification users who received their ADT hearing aids from one of two private practices in California and Oklahoma. In addition, WTP was examined alongside patient-related variables such as hearing aid benefit, annual income, unaided hearing difficulty in background noise, importance of hearing, and satisfaction with services. Results Using the catastrophic approach, the hypothetical purchase of one hearing aid at an average selling price of $2,367.50 would not be affordable for 61% of Americans and 75% of those with SRSHD. At the same price, 2.4% of Americans and 3.9% of those with SRSHD would fall under the US FPL for the year as a result of the hypothetical purchase. Rates of affordability were significantly lower among those with SRSHD, those of non-white race, females, and those with lower educational attainment. The return rate for the postal surveys was 16% (70 respondents / [500 surveys sent − 50 return to sender]). Average WTP for one advanced digital technology (ADT) hearing aid was $1,800, while WTP for an OTC device was most commonly $0 (i.e., not willing to pay). Hearing aid services were commonly valued between $0 and $250. Income was strongly associated with WTP for an ADT hearing aid, where those with lower incomes were more likely to report lower WTP. No other associations between patient-related factors and WTP were identified. Conclusions Providing low-cost hearing aids can help alleviate the financial burden associated with hearing aid costs. However, findings also indicated that cost-reduction can make HHC and devices more affordable, but lower costs do not necessarily translate into increases in perceived value of these low-priced OTC and direct-to-consumer (DTC) options. Indeed, the present sample of hearing aid users expressed the lowest WTP values for the low-cost amplification option. With expected increases in the DTC hearing aid market, pricing should be congruent with perceived value (i.e., benefits per dollar spent) to assure that product offerings are in alignment with consumer preferences for hearing aid adoption.