Why Can't Industry Design an Affordable Hearing Aid?

Hugh Pickens writes "Tricia Romano writes in the NY Times that over the last 10 years, purchasing a hearing aid had become even more difficult and confusing than buying a new car — and almost as expensive. 'I visited Hearx, the national chain where I had bought my previous aids. There, a fastidious young man spread out a brochure for my preferred brand, Siemens, and showed me three models. The cheapest, a Siemens Motion 300, started at $1,600. The top-of-the-line model was more than $2,000 — for one ear. I gasped.' A hearing aid is basically just a microphone and amplifier in your ear so it isn't clear why it costs thousands of dollars while other electronic equipment like cellphones, computers and televisions have gotten cheaper. Russ Apfel, an engineer who designed a technology now found in all hearing aids, says there is no good reason for the high prices. 'The hearing aid industry uses every new thing, like digital or a new algorithm, to raise prices,' says Apfel. 'The semiconductor industry traditionally reduces the cost of products by 10 to 15 percent a year,' he said, but 'hearing aids go up 8 percent a year annually' and have for the last 20 years."

Comments

three words, one hyphen:

[Black Parrot]

for-profit healthcare

Re:three words, one hyphen:

[malraid]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

Re:three words, one hyphen:

[pixelpusher220]

and lots of people who need them wouldn't get them...

Re:three words, one hyphen:

[K. S. Kyosuke]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

This stuff almost feels like defense contracts, actually. Easier to throw money around when it's someone else's money.

Re:three words, one hyphen:

[Hadlock]

If teenagers can afford a smart phone (+ monthly data plan), I suspect a usable hearing aid could be manufactured for the same price, even if it doesn't have 3G internet and multitouch display.

Re:three words, one hyphen:

[malraid]

Maybe lots of people wouldn't be able to get them. Or maybe prices would drop enough that you be looking at most people being able to get them. Given the nature of most electronic products, I wouldn't be surprised if competition wouldn't drive prices down so much that most people who have insurance right now, would be able to afford them (basic models close to what people pay right now for the insurance copay). In that scenario (which might be too idealistic), some people wouldn't be able to get them anyhow, same as now people without insurance don't have much option.

Re:three words, one hyphen:

[jmichaelg]

I'll see your three words and go in two; no hyphen: Regulatory Capture.

Healthcare is expensive because the government passes scores of rules that benefit the incumbents and keep out innovation. They pass those regulations because someone ends getting richer as a result.

  Ear Trumpet's developers received a cease and desist from the FDA after they published an iPhone App that tested your hearing and then loaded an equalizer to adapt playback response according to the test results. That's all they were selling - a test and an equalizer with presets. But you can't buy it anymore because the FDA objected.

Another case in point. One of my students' father was trained as an M.D. in China. The family emigrated to the U.S. and the father had to go through medical school all over just to prove he knew what he was doing. The only thing that improved in med school was his English. Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet. But no. The medical profession protects its own from competition by convincing everyone they know best by limiting the number of doctors and med students.

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

Re:three words, one hyphen:

[Anonymous Coward]

A medical doctor I later tried unsuccessfully to fuck told me that one factor in skyrocketing healthcare costs, in America at least, was the increasingly litigious environment driving up malpractice insurance and prompting medical centers to order increasing numbers of unnecessary tests so the patient won't come back later and sue the living piss out of the hospital because they had missed something unrelated to what the patient came in for.

It's funny how the American pigs point the finger at "greedy insurance companies" even as they considered suing that mom-and-pop store for millions of dollars because they almost slipped on a floor.

-- Ethanol-fueled

Re:three words, one hyphen:

[Anonymous Coward]

No, it isn't "for profit" per se that causes the high prices. It begins with the way consumers perceive their insurance plan. They see the insurance payment as a sunk cost, and don't really want to spend any less than the maximum that the company will pay. In addition, most people are willing to pay extra out of their own pocket to get better equipment, so the hearing aid companies set their prices to encourage that. The medical device designation is a significant barrier to entry, and so minimizes competition. These factors combine to set the price.

Re:three words, one hyphen:

[PopeRatzo]

Given the nature of most electronic products, I wouldn't be surprised if competition wouldn't drive prices down so much that

The iPad mini is evidence that competition doesn't reliably drive prices down.

When you have products that are highly desirable (and if you're hearing-impaired, a hearing aid is highly desirable) then prices will stay as high as people are willing to pay.

There is no "law of supply and demand". It's a fiction.

Re:three words, one hyphen:

[udachny]

I just explained to somebody in another story how FDA stands in the way of people getting help they need, and here is another silly comment that I am replying to.

For profit health care is the solution to the problem.

The problem is government in health care, preventing all people who want to make a profit in it from participating in the market.

The problem is government intervention into health care, the FDA and all other regulations. Anybody with an EE degree (and even those without, but who learned on their own) should be able at least to try and provide a solution to this problem of expensive hearing aids, and they certainly should be doing it in an attempt to achieve profit, which would only indicate that they are on the right track (and here is another comment explaining why the profit motive is the only moral motive that we know works).

Any high schooler with an interest in electronics and with a pair of hands should be able to attempt and build a device that would help a person with bad hearing, but very few high school students have the money and connections needed to take on the government machine, that stands on his way, protecting the monopolies and oligopolies that government prefers.

Of-course governments prefer monopolies, that is how governments can ensure huge potential monetary sources to run election campaigns and pad politicians' bank accounts.

The for-profit motive is not the problem with the industry, the for-profit motive is the problem with the government.

Re:three words, one hyphen:

[Chuckstar]

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

It would also be much less effective and much less safe.

The free market doesn't fix everything. In fact, the basis of the current regulatory regime regarding new drugs was originally put in place because a bunch of consumers were killed by a bad drug... with especially painful-sounding deaths... the company never performed any testing with the formulation... and should have known there was a problem in the first place. The story is: Massengil used diethylene glycol as a solvent for dissolving sulfanilamide into an elixir format. Diethylene glycol was a known poison, but the company's chemist wasn't aware of that. Even very simple animal testing would have found the problem.

So how about instead of ridiculing every action the government takes, we all get together and try to limit the useless actions and focus government on the useful ones? Requiring drugs to be tested and shown to be safe and effective is a Good ThingTM. Whether in the U.S. or in countries with weaker regulatory regimes, we've seen time and time again that the free market is simply not up to the task of keeping ineffective or even dangerous drugs from being peddled to consumers. However, some of the detail of how the FDA reviews drugs might be amenable to streamlining (I don't know enough detail to suggest how, but it seems almost certainly probable).

On the other hand, your description of Ear Trumpet's experience with the FDA seems like a Bad ThingTM.

I'll bet if you got 10 Republican and 10 Democratic congressmen together (and could somehow figure out a way of making them ignore the fact they were working together), you could find 20 ways that everyone would agree would streamline the FDA without materially affecting the quality of health care. In decades past I would have said the biggest impediment to such agreements was that no one in Washington really cares to put such effort into low-profile results. That still might be a problem today, but the bigger problem in Washington today is the part I put in parenthesis above -- not only is there a divide that makes it hard to work together, congressmen are actively disincentivized from working across the aisle, in spite of rhetoric to the contrary.

It's too bad, because there are plenty of opportunities to streamline government. Only the Republicans think streamlining is bad because it gives the new streamlined regulations more validity -- "we don't want better regulations, we want NO regulations". Democrats think streamlining is bad because simpler regulations can have larger loopholes -- "regulations should be intricately taylored to each situation so that big business can't slip anything (no matter how immaterial) through the loopholes."

As far as the MD trained in China... the problem with just letting foreign doctors practice here is that the quality of training varies dramatically overseas. The doctors in China who went to better universities and trained in better hospitals are probably on par with U.S. doctors. The ones who went to smaller, regional universities and trained in rural hospitals may not be qualified to practice in the U.S. A written exam wouldn't be able to distinguish, but maybe there's a middle-ground where a few U.S. institutions would be qualified to run 2-year residency programs where foreign doctors' skills are put to the test. The ones that pass get full MD privileges. The ones that don't get kicked down to medical school to start again.

See? There are possible compromises to these things. We really, really don't want a free-for-all in the healthcare system, though. It would be monetarily cheaper, but at what cost in lives?

Re:three words, one hyphen:

[Arthur B.]

for-profit healthcare

Right, because every other electronic device - the prices of which keep falling - are produced by not-for profits.

Among many reasons are the high costs of medical regulation, liability insurance, the fact that paying with insurance seriously blunts the pressure on prices. But no, let's just say it's "greed" and feel self-content with a non explanation.

Re:three words, one hyphen:

[tburkhol]

If it were individual, it would be like a car salesman... attempting to charge the highest price, ask you to take out a loan and pay it.

Yes, but if you don't like the car salesman's deal, you have to take the bus. If you don't like the hearing aid salesman's price, you're deaf. If you don't like the surgeon's price, you're dead.

You can't negotiate healthcare on a level playing field, regardless of who writes the check.

Re:three words, one hyphen:

[Imrik]

How would those few thousand deaths compare to the lives saved by proper medical care as a result of lower prices?

Re:three words, one hyphen:

[AlphaWolf_HK]

Or perhaps, it's just "hip" to buy an iphone, and the high price is why people want them.

When Gucci lowered the prices on their designer clothing, their sales volume dropped. Were talking volume here, not profit. By raising the prices again, they actually sold more clothing.

When you put a high price on something, in many cases it can make people desire it more. I guarantee that if apple dropped their prices, they would probably sell less as well because it wouldn't be this trendy thing that only the "hip" or
"sophisticated" people have any more.

Anyways, over 500 years of market history will tell you that supply and demand isn't fiction. Only a die hard communist chooses to ignore that.

Re:three words, one hyphen:

[tmosley]

That's like saying that pilots break the law of gravity. The laws of economics aren't enforced by policemen, they are a result of natural human interactions.

Funny how you attribute the perverse behaviors of individuals under the influence of government imposed regulations and incentives to the "free market". If a farmer in a free market burned his crops, he would drive the price up for all the other sellers of that crop, and he would lose market share. Anyone who did this regularly would go out of business. You need to stop confusing commodities like food crops with brands like Apple.

Simple

[Anonymous Coward]

Economics of scale. Semiconductor industry sells a lot of chips. Hearing aid manufacturers don't sell that many hearing aids.

Because it's a medical device.

[josiahgould]

Regulations, testing, etc, will all drive the price of the unit up. But in the end it's because the manufacturers have figured out what the highest price an average insurance company will pay, and put it right at that point.

Re:Because it's a medical device.

[PlusFiveTroll]

This right here.

Put the word 'medical' in front of anything and you add a zero or two to its price tag.

It isn't just about insurance companies

[Ronin Developer]

Today's digital hearing aids are actually very sophisticated devices. People with hearing loss don't need all frequencies (and noise) amplified. Typically, their loss is toward specifics frequencies. The new hearing aids are programable and can enhance the specific frequencies to compensate for the user's hearing losses.

   

Re:It isn't just about insurance companies

[Anonymous Coward]

that isn't sophisiticated in the least. It's called an equalizer and it's extraodinarily easy to implement.

they know what the market will bear and are charging every cent of it.

there's clearly no competition, the question everyone should be asking is, why not ?

You can have 2: cheap, realtime, or resolution.

[Miamicanes]

Hearing aids are unique among consumer electronic items, because they have almost zero tolerance for latency. If the media stream coming from your entertainment device is delayed by 12ms, you'll never notice the difference. If the sound coming out of your hearing aids is delayed by 12ms, your ability to locate items by sound and react to them is going to be completely borked. At best, you'll be stressed out and irritated. At worst, you'll feel disoriented and confused.

The problem is, all of the cheap ways to do digital signal processing add intolerable amounts of latency, so hearing aids are stuck with hybrid analog+digital designs that try to keep their filtering problems in the domian where they can be resolved the fastest. With digital designs, you can get away with sloppy designs that have corners cut and mostly get away with it if premature failure is OK as an option. With analog designs, every penny you shave off is going to have consequences, and those consequences add up quickly. Mixed-signal designs are the worst of both worlds -- you have to use premium-quality components and be aware of analog signal behavior every step of the way, then turn around and try to fix the noise and artifacts introduced by the digital part as well.

Yes, a hearing aid that simply amplifies sound through some cheap analog means, maybe with simple filtering, would be very cheap to make. However, for most users, that kind of hearing aid would be about as useful as a pair of drugstore reading glasses for somebody who has astigmatism. For profound hearing loss, making speech recognizable is about as hard as trying to fix botched laser surgery that's left somebody with higher-order optical aberrations that simply can't be fixed by a simple symmetric lens.

God/Nature/the Univrese has a cruel sense of humor, and here's an example that will make sense to people who had high-end car stereos at some point in the past. Remember what happened when you ran your stereo's line-level signal through a low-pass filter to separate out the bass channel? It flipped the phase, and made it lag. At the time, you probably dreamed of the day when you could use a DSP to implement an infinite-slope crossover that fixed both problems. Then, years later, you learned the cruel truth: in order to implement such a filter, you had to wait until you had a few thousand samples to analyze and work on... and the time you had to wait until you had a big enough window of samples to analyze ended up being almost exactly the same amount of time that the analog low-pass filter delayed the bass. The digital breakthrough is that if you don't have to do that analysis in realtime, and you have enough storage space to analyze the music offline, then re-sync everything up and store all the individual tracks separately, you can achieve the flawless perfection you always sought as a teenager with laggy bass. It's now cheap and easy to do, because you can take a whole CD, rip it to raw PCM, analyze it with your PC into separate 16-bit audio tracks for every single speaker element in your car, tweak their phase relationships to your heart's content, then write it all to a microSD card & have room to do the exact same thing to a few dozen more CDs.

The problem is, hearing aids don't have that luxury. They're one of the hardest-core realtime applications out there. You can't sample the sound, recursively process it, then go back and remix it at your leisure until it's *exactly* right, then play it over and over again thereafter. You have roughly half of a millisecond to do what you're going to do and send it to the transducer in the user's ear canal.

Of course, there's a big gray area of users whose hearing problems wouldn't be solved by cheap analog hearing aids, but like someone who's got a diopter of astigmatism and moderate far-sightedness, a pair of $12 reading glasses from the rack at the drug store would probably be better than nothing at all. But make no mistake... even if you could embrace the hacker/maker ethic, buy your own best-of-breed he

Re:You can have 2: cheap, realtime, or resolution.

[Lucidus]

But they do sell millions. How many old people live in Europe, Japan, and the USA?

two words, no hyphens

[Anonymous Coward]

Regulatory capture

More than meets the ear

[Alomex]

A hearing aid is basically just a microphone and amplifier in your ear so

This is like saying that a Ferrari is basically a VW bug on a race track so why is it so expensive? [yay car analogy!].

A good hearing aid has a microphone, speaker, battery and amplifier which are 1/50th the size of the one in your cellphone yet deliver much higher quality of sound all while filtering undesirable sounds.

Yes, in my opinion they are overpriced, but arguing that they are just a microphone and an amplifier is just ignorant.

Re:Shooters' earmuffs

[DarthBling]

If you want electronic ear plugs that do the same thing as Shooters' earmuff, be prepared to spend a bit more money than $50 to $100. Still, to get a pair of custom molded ear plugs made, it'll only will cost you between $100 to $200, and that's just for simple ear plugs. You add in the electronics and the price will go up a bit (around $50 to $500 depending on what you're getting). Hearing aids aren't much different than these "off-the-shelf" ear plugs, they're just a bit more sophisticated since they can be tuned by a audiologist to address each individual person's needs.

I had a set of custom ear plugs made a couple years ago at a motorcycle shoe and each pair was $55. Quite the bargain. Just recently, I had another set of custom ear plugs made that come with Noise Brakers and those set me back $120 or so directly from manufacturer (they're local to me, so I just stopped by their building).

Do I think hearing aids actually cost $2000 a pair? Absolutely not. So why are they so expensive then? I believe it's due to a serious lack of competition. Most people who get hearing aids are probably getting them through their insurance company or the VA, so costs are a minimal concern to them as they only have to pay their co-pay or deductible. But if you want to buy them direct yourself, the prices are outrageous and most people will just forgo them and suffer in silence. On a whim about a month ago, I went to a Sonus Hearing store and asked how much they charge for earplugs and they wanted $150 just for the impressions! Plus, I would still have to pay whatever the cost was to have the actual earplugs made. Who do they charge so much? Because they can.

WTF Again?

[Osgeld]

http://ask.slashdot.org/story/12/06/13/1828232/ask-slashdot-why-are-hearing-aids-so-expensive
http://science.slashdot.org/story/11/09/09/2346233/is-there-a-hearing-aid-price-bubble
http://ask.slashdot.org/story/10/03/13/1916203/why-are-digital-hearing-aids-so-expensive

simple:
insurance
medical device
niche market

just because you are deaf, it doesn't mean that you are too blind, stupid and lazy to look at the last 3 years of the same fucking article with the exact same answers.

Re:You get what you pay for

[Chuckstar]

This is a good point. It's possible that many people with moderate hearing loss are overpaying for aids that are overkill for their condition. For people with more difficult to address conditions, though, the cheaper ones just don't cut it. My dad has severe tinitis, with associated hearing loss.* He tried hearing aids at all price levels. Only some very expensive ones worked well enough for him to even bother with (couple thousand dollars per ear, but I don't remember the exact price).

*Recent research into tinitis seems to lean towards the hypothesis that I worded that backwards. The old hypothesis was that the ringing sound makes it hard to hear in that range. The new hypothesis is that the ringing is a side-effect of losing hearing in that range -- i.e. it is the equivalent of phantom pain when a limb is severed.

Re:One word...

[nbauman]

Medicare.

Medicare doesn't cover hearing aids.

Medicare does cover cataract surgery, and the price of cataract surgery has dropped dramatically over the past 30 years.

Re:custom fitting costs roughly $100

[Americano]

Okay, so now you've added R&D costs for a home-configuration device, and need to test and certify IT to make sure that it's not accidentally blowing out someone's ear drums, and you need to support it on dozens of different devices, and make sure it's secure (bluetooth hack + self configuring = your $1600 hearing aid is bricked). I'm sure that will drive down the costs of the device signifcantly.

The devices cost "over a thousand dollars" because the devices are complex pieces of integrated circuitry which have to operate continuously, reliably, in a hostile-to-electronics environment (the ear canal isn't exactly a cool, dry place), be comfortable, energy efficient, and safe, and last for a minimum of several years.

This argument that "these things should cost way less" is silly - they're NOT phones, they're NOT tablets, they're not laptop computers. They're highly specialized devices, selling to a limited sized market, with much stricter operating parameters, and high efficiency and safety requirements. Relax all of those, and perhaps you can make one cheaper - but it's going to be less reliable, less durable, less safe, and generally not a very satisfactory experience for someone who actually needs the device.

Two words: dumb customers

[ShanghaiBill]

Certainly the free market isn't driving down the price...

The free market only works if customers aren't stupid. The guy in TFA goes to one reseller, and looks at hearing aids from one manufacturer. Yet even he admits that he could get one for far less "on-line", but for some reason he doesn't fee that is an option. Why not?

Two months ago I bought a hearing aid for my father-in-law from Amazon for $329. He describes it as "fantastic". So TFA's claims that nothing is available for less than $2000 is clearly nonsense.