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Why Are Digital Hearing Aids So Expensive?
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."
"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.
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).
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.
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.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
Kind of, not really. We are in a really weird position. Our device is a kiosk with metal brackets for hanging other devices on. At the root of it, we are a class I, but because we talk to class II and III (12-lead ECG) and because we shuttle data around, we are a class II. Although there is the risk the FDA could come back and say we are a class III given that we talk to a class III.
:) http://afhcan.org/cart.aspx
The project is a lot of fun in spite of the FDA
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.
Why is there an "insightful" mod and why isn't it "-1"? If I wanted insight, I wouldn't be reading
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.
Well, I've now seen at least one steampunk hearing aid:
http://turonistan.blogspot.com/2009/12/steampunk-hearing-aid.html