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Ask Slashdot: Why Are Hearing Aids So Expensive?
solune writes "You can get a tablet these days for a few hundred dollars, and laptops for a few hundred more. Gaming consoles, TVs, and smartphones are all available for under a thousand bucks. Yet, a decent hearing aid for my mom will go upwards of $3000! With ever-shrinking electronic components, better capabilities, and technological advancements, not to mention the rapidly increasing potential user base, I would think quality hearing aids should be coming in a lot cheaper than what we can find. Adding fuel to my fire is that a hearing aid will greatly improve my mom's life — not to mention the lives of millions of others out there. Currently, she suffers from frustration and isolation with having to ask people to 'speak up', and nodding her head to things her kids and grandkids say. We've tried the cheapies, and they're fraught with problems. So, can someone tell me why a hearing aid should be so expensive?"
'nuff said
About 2 to 4 of every 1,000 people in the United States are "functionally deaf," though more than half became deaf relatively late in life; fewer than 1 out of every 1,000 people in the United States became deaf before 18 years of age.
However, if people with a severe hearing impairment are included with those who are deaf, then the number is 4 to 10 times higher. That is, anywhere from 9 to 22 out of every 1,000 people have a severe hearing impairment or are deaf. Again, at least half of these people reported their hearing loss after 64 years of age.
Finally, if everyone who has any kind of "trouble" with their hearing is included then anywhere from 37 to 140 out of every 1,000 people in the United States have some kind of hearing loss, with a large share being at least 65 years old.
So even at 140, even ignoring those that cannot be helped by hearing aids and those that cannot afford hearing aids, the truth is that far more than 140 out of 1,000 people buy the products you mentioned. If you move a higher volume, you can price them lower and approach their true cost as your design and overhead costs diminish with numbers. What's more is that "a laptop" will more or less work for me the same as it will work for you. We don't need to mold the laptop to put it in our ears or have it tuned to our needs.
You also seem to overlook two factors: as electronics get smaller they get more expensive. The second part is that as electronics need to power themselves and get smaller they get even more expensive. And on top of that, my cell phone puts out a lot of heat. The kind of heat I would not want in my ear. So you have to consider that the battery must be small and must not dissipate tons of heat and so therefore the electronics must have a very low power draw. There's not much of a conspiracy to find here, it's an unfortunate reality that prevents someone from storming the market with the new better cheaper hearing aid (pending tech advancements).
In my family, we look at chipping in to buy our elders hearing aids for presents, I know the nice ones are crazy expensive.
My work here is dung.
Most hearing aids are vastly more complicated than just a volume increasing device. They actually take sounds received on certain frequencies and rebroadcast them on frequencies your mom can hear better on. Thus why they are prescription based like glasses.
Here is a more technical and probably more accurate description:
http://en.wikipedia.org/wiki/Hearing_aid
In the UK it's largely because the 'price' includes 'recovery' of all the audiologist's time and overheads which are misleadingly presented as 'free'. Try buying it used, and no one will set it up for you. Cartel point is valid too, similar reason.
http://www.embracehearing.com/
Just add {In Space!} to anything.
I just bought two state of the art power aids from Costco for 2k, so 1k apiece. They seem to be working just fine for me. They probably would have been 3X the price from a conventional hearing aid dealer
"my hearing aid made my pacemaker crash" would be pretty shitty.
So would "my hearing aid shorted out and burned the inside of my ear". Or "everyone runs away when I approach because they are tired of the constant feedback my poorly fitted heading aid emits.". So would "I paid extra for a phone that was hearing aid compatible and this hearing aid doesn't work with it."
MOST insurance policies do NOT cover hearing aides. As a person who's been wearing hearing aides for the last 30+ years, I can guarantee you this. Only if you work for a much larger corporation with a VERY nice benefits package, will you find an insurance policy that will cover your hearing aides - or even a portion of it.
My last pair cost me just shy of $4000. I paid out of pocket since my insurance at the time didn't cover this expense. This is, to date, the second biggest expense I've ever paid, after my car. They were top of the range 11 years ago. I can buy an equivalent model now with the same features from Costco's hearing center now for about $500 each.
Maybe your mum doesn't need the top of the range aides? Try looking for some with fewer features - say only six channels and two or three programs each (one program for normal environment, one for noisy environment, and one for telephone use if she should so desire). You'll save a ton of money.
The other reason why hearing aides are usually so expensive is that not everybody has the same ear shape. All in-the-ear aides are made from a custom mold, which does increase the cost. My dad recently got a behind-the-ear pair that didn't include a custom mold. The tips fit into the canal, similar to a pair of newer earbud headphones. (They still cost him $1200 for the pair though.)
Your mileage may vary. I highly suggest you shop around. Just remember though - you get what you pay for, and always buy the insurance plan on the li'l buggers.
Mod parent up! I worked in the hearing aid biz. Heck, you have FDA coming in looking for rat droppings - you can't describe the horrible tangled mess the regulations and implementers are. Then there's the question of making loud noises into the ear of someone who already has a loss...legal liability. Same issues for most medical gear. I've seen some amazing prices on laptop based EKG's, as in, way too many digits. But....insurance pays, the gov makes sure they make money, and tries to make it so the guy who slaves to make a good aid - they have to be customizable (and by a medical type) for your situaion - makes no money. It's a hard biz to be in.
Why guess when you can know? Measure!
I see them now too, that hook up with bluetooth to ones cell phone to make talking on those easier.
There's quite a bit of high tech audio processing in these things...and with the research and all, and lets face it...proprietary, patented algorithms and the like....it isn't cheap to make a quality hearing aid these days. They're packing a lot more than just amplification in these tiny units.
One important step is...get with a GOOD audiologist that you can work with...for testing and picking out the ones with the features that work best for you or those that need them.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
They are in fact mass produced, only the earpiece is custom moulded and that is done by the doctor.
A friend had to get a pair after his hearing was damaged in Afghanistan, a pair of automatic rifles going off next to your head to kill the scumbag running at you with a RPG.
His hearing aids are identical to the ones you can buy for hunting. Except his has a custom software EQ curve installed for his specific hearing loss.
Do not look at laser with remaining good eye.
- hearing aids are Class I regulated medical devices... I can only imagine the amount of bureaucracy that must be involved to obtaining that classification.
That's pretty much the only thing you've said that matters. Well that and the fact that most of them are at least partially customized to the patient. Unlike some products which are significantly cheaper in canada because of collective bargaining and our healthcare system refusing to waste money on billing the way the US does, hearing aids are about the same here.
To sell any medical device it goes through layers of scrutiny. My grandfather in india had a hearing aid where he could hear people fine, but he couldn't hear phones. (I doubted his honesty of hearing fine, but he could at least understand what I was saying from another room with a north american accent speaking english even though he spoke hindi as a first language). But it never worked over the phone. Bizarre. Shit like that wouldn't ever be tolerated by a north american consumer, or by a north american insurance system (government or private).
It also depends very much on what problem you have. Some of the cheap hearing aids do work fine if you have one type of hearing loss but not another. If you need a bone conduction hearing aid (Baha branded) you're looking at 3grand, if you need a cochlear speech processor you're taking 5k or more. The term 'hearing aid' covers fairly simplistic devices to very sophisticated ones. If you have a rare or complicated problem expect rare, expensive solutions.
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 to the OP - 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.
Hearing aids are Class 1 Medical devices.... that's the same category as a toothbrush. You don't need to vising a licensed dentist with trade lobbyists to get a toothbrush.
This is why you can buy hearing aids off of TV, the internet, all without a fitting, or a clue what you are getting... Kinda scary because an improper fitting/setting can deafen you.
What I tell people when they ask why they are so expensive - cost in making them. Each hearing aid (in the ear/canal) is custom made by hand, if done wrong, it is re-done at full cost, but the customer doesn't pay for remakes (as stated above). Plus the hearing aid isn't "Make everything louder". It's a very complex device. Think of an expensive home stereo, the type with a bunch of sliders. Now shrink that and put it in your ear. Only have hearing loss in the 1.5 khz range? then that is the only thing boosted... or the sound in that range is shifted up or down. Different environment? have the aid automatically adjust from a noisy lunchroom mode to park mode when you walk outside. Add in directional sound detection so the aid knows the voice in front of you is likely the one you are listening to and not the voice behind you... Add in wireless communication between aids to help find the direction where sound is coming from, plus use media streamers to listen to the TV. Do all of that in something about the size (maybe smaller) than a pen cap.
And no, Health insurance doesn't cover hearing aids (most of the time, maybe there is a few, but that is the exception, not the rule).
if (it != oneThing) it = another;
Chips are small. It's the nature of the device, if you ever enlarged the microprocessor in your computer to a size where the optics in your eyes could see it then you couldn't fit it in your room. The circuit for a hearing aid is a couple of filters and a few op-amps, these can often be placed on he same breadboard with discrete components, not an overly complex circuit.
Micros-processors don't consume much power either. I've spoken with developers in the field and then are designing circuits that loose so little power that the batteries natural discharge rate without load is greater than the power consumption of the device. What this means is that the circuit will have no noticeable impact on the life of the battery. The biggest impact you might have in a hearing aid is the speaker, which is probably where most of the power draw is and possibly most of the cost. But even high quality ultrasonic speakers can be purchased for less than a few hundred bucks and they are the most expensive speakers I can think of.
As for heat, heat is produced by inefficient circuits (yes this means that your hot cellphone or computer is very inefficient), it's just wasted power. When you have transistors operating close to their frequency limit then you will have a lot of wasted power as the transistor starts to operate in an inefficient mode. With the audio spectrum, being only between 1KHz and 40KHz for your average adult i doubt that you will ever see a hearing aid reach this level. Even a micros-processor can achieve several hundred mega Hz without getting hot or suffering for significant heat or power inefficiencies. And these circuits often cost cost a fraction of a cent each to manufacturer, even the expensive ones don't cost more than a few dollars.
Okay how about the molding? Well with 3Dprinters and injection molding having become fairly cheap in the last few decades I can honestly say that these costs are probably no more than a few dollars.
What about development, well this might justify the cost. If they had to custom design a circuit for your specific hearing problem. But since you can pick many of these up with a week I seriously doubt that is the case, because the licensing for that particular device couldn't be approved in that time.
What about licensing and testing? Here is the tricky part this is medical device, so these costs are rather high but it's only a one time cost per device model so this cost should go down for "proven" devices. Even then this shouldn't be that big of an issue as the device is not going inside the body. and as long as they ensure that the device never produces a harmful emission (sound/explosion/battery leakage) the costs should be negligible to the consumer.
So what have we learned? Well the cost should be at most a couple of hundred of dollars probably no more than a quality cellphone, and most of that is because of the speaker for the device. So where do all of these costs come from? I'll leave that up to your imagination. Personally I'd just go down to your local Radio Shack and for about 20-30 dollars in parts (mostly the headphone cost.), an Altoids tin, and some circuit design knowledge, you could get the same product, just a little bulkier. If you ordered the parts online you could get them cheaper and of higher quality. Since i already know how to do all of this I'll let you guess the route I'll take. Heck i already have everything I need in my tool closet.
I'm a very satisfied customer.
Just like college tuition. The easier it is to fund an education the more expensive it gets.
Definitely there's more paperwork involved with a Class 1 medical device than say a DVD player, but if both manufacturers follow good management and development practices, it's not really that much more paperwork.
If a persons hearing in each ear is charted, frequency versus sensitivity you fine a lot of variation in people with hearing loss at various frequencies caused by various legal and not legal drugs, loud music, impulse noise from Guns of jets etc. The hearing aid is then programmed to boost/cut various frequencies to get as close as possible to the natural ear with no deficiencies. They have built in equalization. The better the resolution of this equalization and the better the job the audiologists do and the better hearing aid purchased = best results. The hearing aid itself has a base cost of about $50, plus fees to program each one, test with the person in a quiet room, fit to the ear drum shape etc, all adds cost. Low power, more efficient units cost more = last longer on smaller battery
That said, there are many ripoffs out there, and many locked up distribution channels by people who want to sell a $50 item for $2000. Hearing loss forums can help, but they get a lot of manufacturers shills in there, takes a while to know the crooks.
Do you realise how much it "costs" to configure a digital filter? The answer is, next to nothing.
Programs like MATLAB can calculate the necessary coefficients on the fly. Any skilled engineer can write a program to convert a given frequency and phase characteristics to a list of filter coefficients. Even if you want to do fancy things like lattice filters it's still not very complicated as most of these are designed by converting the direct form of the filter using a recursive algorithm. Again something a computer can do.
The actual cost I'd say comes from the size of the hardware combined with a good battery. If you wish to miniaturize it'll cost you big time. And quantities in the hundreds of thousands aren't quite enough to warrant the cost of miniaturization as these sort of things will take some custom hardware. Mask fabrication and set-up costs for a run of wafers; well it isn't cheap.
Familiar with duplexer tuning, however a hearing aid is mono-directional, and as solidraven (1633185) says, determining the gain versus frequency profile should be quick. Frequencies that have gone fully deaf - no cochlear hairs left, will probably not be compensatable with an external device, we can directly stimulate the nerves with a cochlear implant, after which the person learns to hear anew. Here is a simple youtube about it http://www.youtube.com/watch?v=SmNpP2fr57A, the comments are also of interest. This search is also useful http://tinyurl.com/cq8bz3w.
It is my understanding that you can buy the programmable chip that is a complete processor heart of a hearing aid from many makers. Here is another search on that topic.
http://tinyurl.com/cwcuwuq.
Even more "Bogus" in that you can get the SAME Siemens #2000.00 hearing aid (US) in Singapore for $180.00 (US).
I killed da wabbit -Elmer Fudd