The trend in hearing aid adoption after provision policy changes in South Korea

The trend in hearing aid adoption after provision policy changes in South Korea

This study used national insurance claims data to assess the effect of changes in the hearing aid provision scheme on annual trends in the number of newly registered hearing impairments and the number of hearing aid subsidies paid. It found that the annual number of newly registered hearing impairments increased slightly and then declined during periods of undersubsidy for hearing aids (from 2004 to 2014) and rose dramatically in response to significant increases in hearing aid subsidies. devices (since 2015). In addition, the proportion of people with newly registered hearing impairment who received hearing aid subsidies increased to 85.3% in response to the large increase in hearing aid subsidies in 2015.

To our knowledge, this is the first formal study to assess hearing aid adoption behavior using a national population database. The results suggest that a realistic hearing aid provision policy can facilitate rehabilitative behavior in hearing impaired individuals.

Hearing loss is the most common chronic condition in older adults. The number of people with hearing loss worldwide is projected to reach 2.45 billion by 2050, an increase of 56.1% from 2019.11. Unresolved hearing loss and inadequate hearing rehabilitation reduce quality of life in many ways, especially in terms of cognitive function11, and recognition of the social burden of hearing loss has grown. To alleviate the adverse effects associated with hearing loss and its sequelae, provision of hearing aids in an audiology clinic is the usual management procedure12. Despite the high prevalence of hearing loss in old age, only a limited proportion of the population with hearing loss who could potentially benefit from a hearing aid report current hearing aid use13,14. In the United States, approximately three-quarters of people with hearing loss cannot afford a hearing aid8. A Korean population study showed that only 17.4% of people with bilateral moderate to profound hearing loss had purchased a hearing aid, and only about 73% of these individuals used the hearing aid regularly14. The importance of diagnosis and treatment of hearing loss is generally underestimated, especially in developing countries11.

The average price of a pair of fitted hearing aids ranged from $2,200 to $7,000 in 2014, and Consumer Reports shows that the average price of 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 cost of hearing aids is quite high and is considered the first barrier to hearing aid adoption15,17. In other words, insurance coverage is an important driver of hearing aid adoption18. The South Korean government has subsidized part of the cost of a 5-year purchase of hearing aids since 1997, according to data from the Disability Welfare Department. The subsidy amount for hearing aids 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) in late 2015.

A previous large study in South Korea examined the 10-year trend in the number of individuals who were registered with profound hearing loss from 2006 to 2015.19. It showed that the trend of hearing loss showed a gradual decrease from 2010 to 2015.19. In the current study, consistent with this report, the number of newly registered individuals with hearing impairment decreased from 2009 to 2013 (Fig. 2A). The decrease in the number of newly registered hearing impairments can be explained by the assumption that most of those motivated by the second level of subsidy ($300) may have completed their registration in the first 5 years.

However, we found that the number of newly registered hearing impairments has increased sharply since 2015, at the same time as the hearing aid subsidy level has increased. This finding suggests that the price of hearing aids has a large effect on the adoption of hearing aids in South Korea. Another interesting point is that the previous study may have underestimated the actual number of people with hearing loss, as there were probably many unregistered people with hearing loss before the larger hearing aid subsidy was introduced19. To be registered as hearing impaired in Korea, three pure-tone audiometric tests and an auditory brainstem response test must be performed, and the cost of these hearing tests is about $250 ~ $300. Given that the cost of the assessment approached the hearing aid subsidy prior to 2015, there was little incentive for people with hearing loss to register as hard of hearing. In addition, the actual value of the hearing aid subsidy would have declined continuously between 2004 and 2014 if inflation was taken into account.

The present study also examined the annual trend of severity among newly registered hearing impairments from 2004 to 2018. The frequency of grade 2 and 3 hearing impairments, indicating profound hearing loss, among newly registered hearing impairments gradually decreased, while the proportion of individuals with severe loss of hearing (impairment degree 4 and 5) increases (Fig. 3). The average age of newly registered persons with hearing impairment gradually increased from 2004 to 2015 and increased significantly thereafter (Fig. 5), meaning that many elderly persons with hearing impairment did not register before 2015. In In addition, the mean time from registration of disability to receipt of hearing aids decreased significantly (Fig. 6), suggesting that the primary goal of registration of disability may be usefully changed to receipt of a hearing aid rather than receipt of other social benefits for hearing impairments.

This study showed that reducing consumer/patient costs of hearing aids by extending the hearing aid subsidy increased uptake in individuals with hearing loss who could benefit from a hearing aid. We found an immediate increase in hearing aid use after the expansion of hearing aid subsidies (Fig. 4). However, there are many other types of barriers to hearing aid adoption besides the issue of cost20. 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 aids21. This low adoption rate of hearing aids may be explained by the complexity of the factors underlying hearing aid use. Hearing aid acceptance is influenced by a complex interaction between personality, perceived social value, and social stigma20,22.

Few studies have attempted to quantify the financial outcomes of hearing loss23. A retrospective cohort study in the United States found that the benefit of hearing aid adoption in individuals with self-reported hearing loss was identified as a reduction in the likelihood of emergency department visits and hospitalizations and reduced Medicare costs17. However, hearing aid use resulted in increased office visits and more overall health care and out-of-pocket costs17. Another study suggests that providing hearing aids ultimately adds value to the health care system and provides net savings to the Medicare program24. After 2015, individuals with severe to profound hearing loss can receive a hearing aid subsidy covering the cost of one hearing aid under the South Korean national insurance system. It will be important to monitor whether the expansion of the hearing aid provision scheme 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 future changes in the provision of hearing aids. Finally, receiving a hearing aid does not necessarily mean regular hearing aid use14,25. Correct hearing aid fitting and testing, as well as counseling, are important in creating an appropriate and effective hearing rehabilitation environment26.

This study has the power to use nationwide population data to examine annual trends in the number of newly diagnosed hearing impairments in response to changes in hearing aid provision. It successfully identified changes in hearing aid adoption by level of financial support. The study also has limitations related mostly to the characteristics of the claims data, as they did not include physical examination data such as the condition of the tympanic membrane and exact hearing level. Furthermore, because the national hearing impairment registration scheme only includes individuals with severe to profound hearing loss, the current study could not assess hearing aid use by individuals with mild to moderate hearing loss. These limitations may be overcome in the future by including additional large medical data sources.

In conclusion, the expansion of the Korean hearing aid provision scheme resulted in a dramatic increase in hearing impairment registration and hearing aid adoption, indicating that there was much unreported or unaddressed hearing loss before the introduction of realistic hearing aid provision.

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