This study used national insurance claims data to assess the effect of changes in the hearing aid supply regime on the annual trend in the number of newly registered hearing impairments and the number of hearing aid benefits paid. It found that the annual number of newly registered hearing impairments increased slightly, then decreased during the periods of insufficient hearing aid subsidy (2004 to 2014) and increased significantly in response to a substantial increase in hearing aid subsidy ( since 2015). In addition, the percentage of newly registered hearing impaired people who received hearing aid subsidies increased to 85.3% in response to the sharp increase in hearing aid subsidies in 2015.
To our knowledge, this is the first official study to assess hearing aid adoption behavior using a national population database. The results indicate that a realistic hearing aid supply policy can facilitate rehabilitative behavior in people with hearing disabilities.
Hearing loss is the most common chronic condition in the elderly. The number of people with hearing loss worldwide is projected to reach 2.45 billion by 2050, an increase of 56.1% compared to 201911. Unaddressed hearing loss and inadequate hearing rehabilitation reduce quality of life in multiple ways, especially in terms of cognitive function11, and recognition of the social burden of hearing loss has grown. To alleviate the negative effects associated with hearing loss and its consequences, the provision of hearing aids in an audiology clinic is the usual management procedure12. Despite the high prevalence of hearing problems in old age, only a small percentage of the hearing impaired population who could potentially benefit from a hearing aid report current use of a hearing aid13.14. In the United States, about three-quarters of people with hearing loss cannot afford a hearing aid8. A Korean population study showed that only 17.4% of people with moderate to profound bilateral hearing loss purchased a hearing aid and only about 73% of these people used hearing aids 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 that the average price for a pair of hearing aids was $ 4,860 in 2021.15.16. The hearing aid market is controlled by a limited number of companies and the price of hearing aids is quite high and considered a prime barrier to hearing aid adoption15.17. In other words, insurance coverage is a determining factor in adopting hearing aids18. According to data on welfare provisions for people with disabilities, since 1997 the South Korean government has subsidized part of the cost of the five-year purchase of hearing aids. The hearing aid subsidy amount 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 conducted in South Korea looked at the 10-year trend in the number of people who registered with profound hearing impairment from 2006 to 2015.19. It showed that the trend in hearing loss showed a gradual decrease from 2010 to 201519. In the present study, consistent with this relationship, the number of newly registered hearing impaired people decreased from 2009 to 2013 (Fig. 2A). The decline in the number of newly registered hearing impairments could be explained by assuming that most of those motivated by the second level grant ($ 300) may have completed registration within the first 5 years.
However, we have found that the number of newly registered hearing impairments has risen sharply since 2015 at the same time as the level of the hearing aid subsidy has risen. 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 people with hearing loss, as it is likely that there were many unregistered people with hearing loss before a larger subsidy for hearing aids was introduced19. To be registered as a hearing impaired in Korea, you need to complete three pure tone audiometry tests and one brain stem hearing response test and the cost of these hearing tests is around $ 250 ~ $ 300. Given that the cost of the assessment approached hearing aid subsidy prior to 2015, there was little incentive for people with hearing loss to register as hearing impaired. Furthermore, the actual value of the hearing aid subsidy would have decreased continuously over the period 2004–2014 if inflation had been taken into account.
The present study also looked at the annual trend in severity among newly enrolled hearing impairments from 2004 to 2018. The frequency of hearing impairment grades 2 and 3, indicating profound hearing loss, among newly enrolled hearing impaired enrollment progressively decreased, while the percentage of individuals with severe hearing loss (disability grade 4 and 5) increased (Fig. 3). The average age of newly registered hearing impaired people gradually increased from 2004 to 2015 and increased significantly thereafter (Fig. 5), implying that many older people with hearing loss had not registered before. In addition, the average time from recording disability to wearing hearing aids has significantly decreased (Fig. 6), suggesting that the primary purpose of recording disability could usefully be changed in adopting a hearing aid rather than receiving other social benefits for hearing impairments.
This study showed that reducing the consumer / patient cost of hearing aids by expanding the hearing aid subsidy increased absorption in 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 obstacles to hearing aid adoption besides the price issue20. 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 aids.21. This low adoption rate of hearing aids can be explained by the complexity of the factors behind the use of hearing aids. Hearing aid adoption is influenced by an intricate interplay between personality, perceived social value, and social stigma20.22.
Several studies have attempted to quantify the financial results of hearing loss23. A retrospective cohort study in the United States found that the benefit of wearing hearing aids in self-reported hearing loss individuals was identified as a reduction in the likelihood of emergency room visits and hospitalizations and a decrease in spending. Medicare17. However, the use of a hearing aid has resulted in an increase in outpatient visits and higher total health care and out-of-pocket expenses17. Another study proposed that the provision of hearing aids ultimately adds value to the healthcare system and provides net savings to the Medicare program.24. After 2015, people with severe to profound hearing loss could receive a hearing aid subsidy that covers the cost of a single hearing aid under the South Korean national insurance system. It will be important to monitor whether expanding the hearing aid supply regime 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 costs, and this information should be reflected in any changes. future to the supply of hearing aids. Finally, adopting a hearing aid does not necessarily imply regular use of the hearing aid14.25. Proper fitting and inspection of the hearing aid, as well as counseling, are important in establishing an appropriate and effective hearing rehabilitation environment26.
This study has the strength to use nationwide population data to investigate annual trends in the number of newly registered hearing impairments in response to changes in hearing aid supply. It has successfully identified changes in hearing aid adoption based on the level of financial support. The study also has limitations, mostly related to the characteristics of the claims data, as it does not include physical examination data such as the state of the tympanic membrane and the exact hearing level. Additionally, because the national hearing impairment registration program only includes individuals with severe to profound hearing loss, the present study was unable to evaluate hearing aid use by individuals with 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 program has resulted in a dramatic increase in hearing impairment recording and hearing aid adoption, indicating that there was a lot of unrecorded or unaddressed hearing loss prior to the introduction of a realistic supply of hearing aids.