Why Are Hearing Aids So Expensive?
nytimes.com
nytimes.com
No, they do.
The short answer is: you need to develop your own custom IC's that 1) have analog circuitry 2) support Telecoil[1] - an ancient induction standard from the 1970's 3) are made by 1 of 4 companies in Copenhagen or Switzerland - one of which has 55% market share and 4) run on fumes. Seriously, the crest factor on these is ridiculous.
The long answer is available in this great podcast episode: https://theamphour.com/338-an-interview-with-jorgen-jakobsen...
Of course, Bluetooth alternatives to hearing aids are being developed. People in the industry know this and joke about it. But, crucially, they can't be called "hearing aids". It's a protected term. An interesting example are Bose's new $500 "Hearphones" strongly targeted at an older demographic[2] with features like Bluetooth and tunable noise cancellation based off their earlier $300 QC30 dynamic noise cancelling platform. But also not the exact same use case. More power intensive. More capable. But less endurance.
[1] https://en.wikipedia.org/wiki/Hearing_aid#Telecoil [2] https://www.bose.com/en_us/products/headphones/conversation_...
What's the cost of your hearing aids?
How many 'hearphones' could you have for, say, 50% of that cost.
10 hour of hearing seems close enough to a day's usage, perhaps a bit shy but probably not by much. Certainly two recharged pairs should see you through a day.
How much charge do they need - or rather, what's the size of a recharge battery pack, and how would you compare the cap-ex of your hearing aids versus the cost /convenience trade-offs of an alternative?
These are pricey though (around 200 EUR), but definitely cheaper than hearing loss.
Etymotic https://amzn.com/dp/B0015WJQ7A
I wasn't suggesting that people only be allowed to hear for ten hours out of every twenty-four.
As noted in the sentence that followed that one you reacted to, I went on to write:
"Certainly two recharged pairs should see you through a day."
TFA, and parent, is about how danged expensive hearing aids <tm> are -- while parent is all about the alternative of 'hearphones' that are around US$500 (about 1/6th of what hearing aids cost in Australia).
(I worry that the smartphone / bluetooth connectivity is too complicated for tech-averse elderly, and that the inline volume controls are too small for arthritic hands. But I like the idea and I love my own QC25s.)
Rather, the problem is that people are currently going without because hearing aids can cost as much as a used car. And the batteries - which do last longer, yes - are one-time-use instead of rechargeable.
Given the choice between recharging something in the middle of the day that costs $20 to a few hundred dollars, or theoretically having multi-day battery life with hearing aids that you can't afford, the former is an easy sacrifice to make.
The great thing about my hearing aids is I put them in and I can ignore them. Unless I'm swapping batteries, which is infrequent enough, I don't even notice I'm wearing them.
Yeah, my hearing aids were expensive. Yes, insurance doesn't usually pitch in at all for hearing aids unless there's surgery required (BAHA, cochlear, etc). It's worth it. The alternatives are toys that get in the way of just going about your normal life.
> Unless I'm swapping batteries, which is infrequent enough, I don't even notice I'm wearing them.
Presumably when you're swapping batteries, you're not actually wearing them, no?
Anyway, I think you have missed the points being made. For people who can't afford, or don't have access to the services around, hearing aids, consultancy, replacement batteries, and so on, there's an alternative.
A more exaggerated example: Someone who is nearsighted using their smartphone to look at more distant objects. Sure, it works, but it's not exactly practical.
The fact that they are cheaper means that they are a substitute for hearing aids.
They may not be quite as good right now ... but we've been over the affordability aspect already.
For people without access to USD $5k for hearing aids, a 'poor substitute' may be a perfectly reasonable alternative.
See, one balanced armature transducer will cost you about this much. Electronics is not the problem, power requirements and miniature size are. In a hearing aid, the main power cost is the transducers (including MEMS microphones) and amplifiers.
BA transducers are so expensive because only 3 companies make them. (Knowles, Sonion and one other I do not remember off the top of head.) Only a few more make MEMS microphones.
This is also on the verge or actually nanotechnology which is why Chinese manufacturers couldn't get in.
Trying to use a dynamic driver or microphone instead will cost you about half of battery life and will be larger.
I'm pretty sure there is space for disruption here.
[0] : https://www.digikey.com/product-detail/en/knowles/SPW2430HR5...
The space requires micromechanical research and manufacturing expertise. Good luck "disrupting" it.
- Far too big
- Requires about 1/3 of the entire power budget
> I'm pretty sure there is space for disruption here.
[hackernews noises]
If they are 1/10th the cost, then the number of people that could benefit goes up tremendously. I'm sure lots of people would accept having two sets that they have to charge every night if the alternative is not having any.
If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance? Or is this like the Epi-pen/Adrenaclick thing?
> If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance?
If insurance plans don't cover hearing aids in general, they won't cover hearing aids in any specific situation either.
GP was asking about insurance plans that do.
Since I only need one hearing aid, the bluetooth feature was of minimal interest. I've not heard of any hearing aids that have a microphone that is useful for the bluetooth headset profile. The microphones for this use tend to be an add-on device which may or may not come with a pair of hearing aids. Admittedly, I've not researched this area much.
However, Grogenaut has also misread Mgerdts's comment to some extent, as when Mgerdts mentioned a "problem" they meant that Derefr's question wasn't that relevant to reality, not that there's a problem selecting hearing aids.
- mics
- DSPs
- drivers (speakers)
- custom wireless chipset
- batteries
i.e. all of the stuff that you need to build a regular HA. The differences are that:
- they have shorter battery life (but a lower capacity battery)
- built in larger quantities
- not 'medical grade'
Telecoil doesn't add significantly to the cost, but it does use a bit of internal volume. They are incredibly useful and are not going away anytime soon.
It's not like you need the 2017 model of HA; for most people the 2000 model would be just fine, and (for the company) the costs of IC development and regulatory have long been recovered. ASICs are expensive to produce, but not that expensive that it adds thousands to the COGS.
The real reason is simple market forces: people will pay a lot of money for healthcare. Insurance coverage in the target market determines much of the price.
That's the whole ball game in electronics.
I'm confused - what part is custom and what is made by the Swiss and Danish companies?
Source: I work in the industry.
[0] https://en.wikipedia.org/wiki/Headphones#Balanced_armature
Sonion
Knowles
Molex
Bellsing
and supposedly sony creates(used to create) some
And probably some others I don't know about.
Some of them cost that much yeah, but not all of them. Nowadays you can get 10BA(though it's more likely 5 doubles each side from china for $600). There are a few exceptions like noble audio that are premium priced with custom units, but most people use factory devices.
You can get 3 BA sub 100 iems on aliexpress. Are they good? sometimes, but the point is I would say there's an audio revolution going on that is hardly noticeable unless you're actively watching it.
I have three pairs of driving glasses, a pair for running,a rimless pair, and a pair for use at work. They are all from Zenni and were all bought 4 to 6 years ago. They have various levels of tinting from none to fairly dark. Antireflection and antiscratch coating were standard. The most expensive was $30.
I would like to buy some new glasses from Zenni, but my optometric prescription has not changed and the frames and lenses are still in ridiculously good shape.
I rejoiced when my work glasses has a nasal bridge fall off. Unfortunately, I found that I was able to repair it in a few seconds.
So despite the pittance that it costs, I still use these old glasses. Perhaps if I carefully drop some dumbbells on them.... :-)
Does it also work when the source of noise is a crowd? I'm near-deaf on one side, which has the side-effect of not being able to isolate voices.
The ideal hearing aid will amplify those frequencies at which speech is present, while suppressing frequencies that contain background noise. But currently hearing aids use a pretty dumb set of heuristics to figure out which is which. For instance they'll try to estimate how far the source of the noise is and will suppress it if it's more than, say 15 feet away. But if your SO is calling you from the kitchen that means that you're not going to hear them. Similarly they'll amplify frequencies associated with sibilants (s sounds, for example) because those are really important for speech, but that means that wind sounds or rustling paper also gets amplified.
There's a huge opportunity here to apply deep learning to determine which frequencies to amplify and which to suppress. It's a challenging hardware problem, but the deep learning part of it has largely been solved. (Or at least, the current state of the art using deep learning is way, way better than what commercial hearing aids currently do.)
why you can't just turn up the volume https://medium.com/@AMP/cant-you-just-turn-up-the-volume-4ec...
You can also toys in some more advanced stuff like ICA deconvolution.
This on top of some nice improvements in plain DSP techniques. (E.g. modified gammatone transform or variants of Stockwell transform)
All in low latency.
The main problem is ruining this on a tiny jellybean power efficient micro. Deep learning on a Cortex M0 with decent quality and less than 5ms latency? Good luck.
The problem is actually finding a "legibility" and "quality" metric. Codec ones like PEQ are not good enough.
The problem with hearing loss is that you can't hear. In most cases, there's a loss of high-frequency hearing, you can't hear sibilants and thus can't parse the speech.
Speech-in-noise is a specific situation that HAs do not handle well. It's less of an issue with un-aided hearing thanks to the shape of our ears.
> The ideal hearing aid will amplify those frequencies at which speech is present, while suppressing frequencies that contain background noise
Every modern hearing aid does this already.
> a pretty dumb set of heuristics to figure out which is which
Dumb? Billions of dollars are waiting for the person who can make noise reduction work really really well. It's surprisingly difficult, even with unlimited computation power.
> they'll try to estimate how far the source of the noise is
This is 100% fiction. No HA on the planet calculates distance-to-noise.
You can spot the HAs that do because they require three microphones not in a straight line. Probably a triangle.
You might be thinking of beamforming, where the HA calculates the direction of the sound and can optionally focus amplification on sounds coming from that direction. Typically, sounds behind the listener are amplified less than sounds coming from in front of the listener. This is a useful refinement done by every modern HA.
> wind sounds or rustling paper also gets amplified
That is unfortunate. There is significant research going into recognising speech patterns so that the HA can make these decisions better. Unfortunately, none have shown useful results yet.
> huge opportunity here to apply deep learning
To do what, exactly? Why DL? How do you propose to run DL on a 1MHz CPU with 16kb of RAM and a battery the size of a bee's genitals?
> It's a challenging hardware problem
The hardware has been known and fixed for 20 years. What would you change? Software is where all of the improvements have come from for a very long time.
> deep learning part of it has largely been solved
Cite me a paper and we can make billions.
> Cite me a paper and we can make billions.
The relevant paper is Hershey et al., 2015 [1]. There are some audio examples here as well [2]. The idea is that a deep NN can apply a spectral mask and isolate a single speaker when many speakers are talking (or there's background noise). Of course a standard hearing aid has pretty limited hardware, which is why the hard part for them is developing a small enough device that can do the inference in real time. (They cheat a little bit and actually do all the processing on a larger device that you keep in your pocket --- it's not done locally behind the ear.)
1. People do not want hearing aids (typically they do not even want to accept they have a hearing loss). You need to spend an awful lot in communication and marketing and humans you can talk to in a store to convince them to try one.
2. Hearing aids are not glasses that you put on and the problem is solved. It takes 6-12 months to get the full benefits and you need multiple visits to the store with humans to hand-hold you through the process or you will just stop wearing them.
And did I mention the average customer is 70 year old? Explain to me how a 70 year old that does not want a hearing aid will buy one online
I'm genuinely interested in the answer, as I am very likely to get hearing loss in the future, and might start being pro-active if there is a cheap alternative I could try right now, before my hearing gets bad.
Keep in mind that the smaller the hearing loss the more sophisticated the hearing aid you need to get a benefit. If you have a slight hearing loss you will experience issues in the "hardest" situations for hearing aids to cope with such as conversations in noisy places or bad telephone reception.
Finally, the over the counter hearing aids come with a limited number of pre-fitted configuration (e.g., 4) and "tweak yourself" means choosing one of them. To get a hearing aid fine-tuned to your specific hearing loss you need a professional in a shop equipped and trained to use with the professional fitting software of the hearing aid
Thanks for your answer. I guess it's not really feasible to get ahead then. I'll probably start with over the counter hearing aids when the hearing loss will start to be noticeable.
I know it will not sound much to you but for those 5k I believe your father got not only top of the line hearing aids but also a trusted audiologist he will be able to see as much as he wants free of charge for the coming years until he decides to get new devices.
Or you need better fitting software that doesn't require a trained professional to use.
I wonder if improving performance would make hearing aids become a "want" rather than a "need"? Bionic ears outperforming natural ones, allowing the user to select different bands/ranges to listen to, sounds like a pretty neat futuristic thing to have.
It's not like people are shy about enhancing their natural abilities with the help of technology, it's pretty much in the current zeitgeist.
Alas, even top range hearing aids cannot do that today.
And if people with normal hearing would wear those it would take away the stigma for people with hearing loss.
Case in point: my dad and grandma. They both got the 'free' hearing aids (we live in Canada) and these supposedly really cost the government (or taxpayers) upwards of $2000 for each ear, and they SUCK. The alternative was to dish out $5000 per ear for a marginally better product. They both ended up not using them because it was such a hassle and it basically drove them nuts. They didn't fit very well and constantly amplified even the slightest noise, and basically did nothing in ways of helping their hearing at a normal conversation.
Recently though, they finally got a great hearing aid (forgot the name) and paid less than $500 (from their wallet) and it vastly outperforms any other hearing aid they've ever tried. I know they work because because they actually WEAR them now because they are NOT ALWAYS BUZZING and amplifying ambient noise and they are ADJUSTED PERFECTLY to hold onto their ears. That's disruption for ya ....
Also the type of hearing aid you need is highly dependent on both the hearing loss profile and the specific life situations when you don't hear well. If you have profound hearing loss and stay mostly at home and need help to watch TV or have conversations in a silent enviroment you can benefit from a basic hearing aid. If you are a bartender with a slight hearing loss and need help in noisy environemnt even a top of the line one might not make an appreciable difference.
Finally free hearing aids always suck because the free service you get with them sucks and they do not take the time to see you multiple times and fix the fitting for you. It is normal to see a customer in the shop for a one-to-one with the audiologist 4-7 times in the first three months. That is expensive and difficult to disrupt because the value is the in human interaction
When he finally accepted to wear them, the situation has been pretty much what you describe. So I would really appreciate if you could remember or ask the name of the working ones.
If your relatives got "free" hearing aids, it's likely they were low end (i.e. less than $500 so totally covered by the government grant). My father had a similar experience with low end devices and thankfully recently bought a much better pair and has finally successfully adapted to wearing them.
I am in no way affiliated to these folks. But I would like to thank them for a great product (on behalf of my family)!
Ugh. That's my dad. He seems to be willing to spend the rest of his life making everybody around him repeat what they said at a higher volume so he doesn't have to try a hearing aid.
The same reason health care is expensive in general.
When side step the regulations and buy outisde the health care industry - say, amazon.com - hearing aids magically become $38.
https://www.amazon.com/Sentire-Med-Enhancement-Amplifier-amp...
Health care is more than ripe for deregulation and monopoly/union busting - but the American medical association lobby is one of the strongest in the world.
A great example is the home infusion industry. People used to make money hand over fist. It took some knowledge to offer home infusion to patients (have a pharmacy, hire some nurses), but it wasn't rocket science. The market was made up of a ton of small companies, all making good money servicing only a handful of patients with certain conditions. We're talking each patient bringing in tens of thousands of dollar of profit each.
There were no regulations or evil conspiracies holding this industry up. It just wasn't big enough for anyone to do anything about. Insurance companies were worried about bigger fish to fry.
Then the large specialty pharmacies came along, bought up all the small players. They used the profits to boost their bottom line.
Then some bean counter somewhere figured out insurance companies were paying way too much, so they renegotiated their contracts, squeezed the profits out of it and now it's like a lot of medical services, single digit profit margins.
There are a lot of markets like this out there. I'll bet hearing aids are one of them.
I'm also reluctant to look at deregulating hearing aids without looking at some of what the regulations do...
Like, something that came up on HN a few years ago was another thread about hearing aids, and one thing I remember from that was that cheap hearing aids can actually do further damage to a person's ears, because of how they do or don't amplify the sounds appropriately.
Maybe the regulations, in this case, are there to prevent people from paying $38 for a hearing aid that wrecks their sense of hearing further. If that is the case--and I don't know that it is, but I think health equipment merits a degree of caution--then I think that's a good place for regulations.
Very few people would be able to properly evaluate whether a given cheap hearing aid would be one that worked without harm or would be one that caused further hearing loss. Very few. That's exactly the place in society for regulations--when few people are capable of making an informed decision, etc.
It's certainly easy to blame regulations for this and everything wrong with American health care, but I don't know if it's sensible here or in general--or if blaming regulations (and consequently removing them) would actually lead to the outcomes people claim they would. My gut tells me that the problems we have lie elsewhere in the medical system, not in the regulations concerning medical devices or medicines.
Generally consumer protection by regulation seems to suffer from a form of regulatory capture -- measures that are great at entrenching the existing players get disproportionate emphasis. You end up e.g. restricting the supply of doctors and then not bothering to make them wash their hands. I'm not saying regulation can't ever do net good, but you have to watch it like a hawk, and who has the incentive to?
I've heard these theories a lot, but I almost never see much evidence; is there any evidence it applies in this situation?
> doctors
I think it's very important to regulate doctors and medical care. I don't want any quack hanging out a shingle and treating people. The same goes for medical devices.
You've just described the intersection of capitalism and human survival instinct in a nutshell.
My mother, who was deaf and wore hearing aids, died in 1989. I always wonder what difference they could have made to her.
If you're paying out of pocket, I strongly recommend that you check out eBay. Second-hand gear is quite cheap.
I picked Advanced Bionics and regularly pay around $2000 a year in batteries, parts (cables, various pieces) etc. alone -- none of which is covered by my insurance here in Japan. Currently I'm waiting on a replacement processor (which is two or three generations old) that I'll pay around $600 out of pocket for. It doesn't seem like much, but due to rain and humidity I end up opening it myself and cleaning it several times a year because I can't afford to get it repaired/replaced.
If I want to upgrade to the newest processor, which is lighter, has better audio quality, and is MUCH more water resistant (a major problem with my current model), it will cost me around $7000 -- and that's a DEAL because the processor JUST got approved in Japan.
After March 2018, the price will go up to $14,000 for a processor. Of course, it's not covered by insurance, so I have to pay for it all out of pocket.
I asked the doctor I was seeing what Japanese cochlear implantees do; I've seen so few successful/independent ones and couldn't imagine any of them paying for any of this. He said they usually hobble along with replacement parts/charity and never upgrade the processor because they can't afford it. He also mentioned that many of them have such a low level of recovered hearing and speech that newer processors, frankly, would not give a measurable QOL benefit, which is another rant entirely...
I'm glad I'm not bilaterally implanted -- there's no way I could afford TWICE the costs.
Surprised Japan doesn't do the same. However, maybe it's an Advanced Bionics thing - we can't get them on the public system here. I chose Med-el (the other option is Cochlear).
> I get upgraded for free every 7 years.
I trade mine in for replacement (on my dime) because it's completely broken every 4-5 years.
> A pack of 50 batteries will cost me $30
A single battery runs me around $200-300. My charger breaks all the time too, so that's another $100-200 depending on what's broken... how are you getting a pack of 50 for $30? What do you even do with 50 batteries?
I have four that I cycle through (the big powercels) but that's because I apparently have thick skin/a thick skull and I only get 10 hours of use out of a battery rated for 20+.
Edit: Oh -- misread! I thought you said you were on AB, but you've got a MedEl. I don't think I've ever actually seen those... they weren't even an option at Hopkins when I was going through the pre-screening. The two options I got were AB and Cochlear.
By batteries, I'm talking disposable batteries, not the rechargeable ones. So 50 will last me a while. I like the disposables best.
This is mine: http://www.medel.com/int/sonnet
Batteries are about $500 each and they last at least a year before they start to degrade. Accessories are not only absurdly expensive, but also basically useless, so I don't waste money on them. It could be a lot worse. It could also be a hell of a lot better. I'd like to be able to hear on my left side too, almost badly enough to pay the $50,000 or so out of pocket that it will cost to get the second implant. My main problem is figuring out who to give the money too. Privately-paid health care is more difficult to get than I imagined.
Wow, that sounds killer for me. My batteries are about half that and last the same amount of time; I buy four or five a year since I cycle through them due to my thick skin/skull that causes me to get half the expected life out of them every day...
What about cables/headpieces/earpieces for that?
Is your government program the Office of Vocational Rehabilitation, by any chance? I went through them in PA and they were spectacularly flaky... and it wasn't helpful that my liaison was someone I'd known for a while since I was friends with her son and she kept pushing me to "give back" in return for receiving benefits.
BC Medical tends to get a pile of funding every couple years for CI patients, like 10 million or whatever, and out of that pile they prioritize younger adults who need at least one CI to be able to hold down a job, people whose equipment is starting to fail, etc. If there's any left after everyone who needs one CI or replacement equipment has got what they need, they can offer second implants. They've never gotten that far down the list though.
That sounds like a relatively reasonable methodology... I would really like to see the balance sheets of these companies to see how much they're gouging us -- I refuse to believe that what's essentially a condom and plastic tweezers really costs $700.
Not broken down to each accessory or anything, but you can see overall profit margins and such.
https://www.sonova.com/en/first-half-results-201617-sonova-s...
http://www.cochlear.com/wps/wcm/connect/b0dffcb0-9826-4c99-9...
Traditional hearing aid companies have no idea how large a freight train is barreling down on them in the form of Apple and Google. It's going to be a fun ride.
Nothing like a bit of justice.
Personally, my money is on Apple and Google squabbling over who gets to buy Cochlear, Oticon, and Starkey for their IP and regulatory know-how, and then just mopping up the floor with the rest of the players in the space.
It's already begun, actually: https://www.wired.com/story/how-apple-is-putting-voices-in-u...
Wired fundamentally does not understand how crappy CIs can be, so it's too enthusiastically reported, but I'm pretty sure this is the opening salvo.
Just curious, can you explain what you mean by CIs being crappy, or point to an existing explanation?
A healthy ear has about 3,000.
It’s more complicated than that, but in a nutshell, the fidelity with which CIs can represent the world is very limited. They work for speech, mostly, in quiet. There are simulations of what they sound like on YouTube, somewhat.
the CI users know are glad to have them, and they are, as you say, a lifeline for many. i’m glad my research ultimately contributes to better ones. we just have a long way to go.
The reality is that you have basically no pitch perception. 16 frequency bands across, say, the four octaves that music is interesting? You're lucky to discriminate half-octaves let alone semitones.
Temporal aspects of music come through alright. I suppose you could be a drummer.
Given that you get ~16 electrodes, and some greenwood-like frequency-place map along the basilar membrane, and given that the place specificity of stimulation from those electrodes is significantly larger than the width of an inner hair cell, I'm not really seeing "200 bands".
Hearing aids though could be ripe for disruption by improved computational power and large supply chain leverage. So it will be a matter of whether or not Apple/Google/ back off once they meet the intractable reality of regulatory compliance in a limited market a la their infrastructure plans.
I think it's most likely that they will buy up those medical companies for expertise, then spin off the medical device manufacturing into a new separate company or otherwise sell it off but keep the key engineers to roll into other random consumer products that are less regulated and more profitable. This is what Google has more or less done with robotics after buying basically every major robotics research company in the US a few years back.
Why not make a startup?
Waiting for large companies to innovate is like saying "I won't build the Apple II because I'd rather wait for the IBM PC to be invented".
The fact that these market leaders (IBM and DEC then, Apple and Google now) have so much power to uproot industries means that people are afraid to pursue their ideas. I don't have a full solution, but investors like Y Combinator are certainly helping.
as other commenters on this thread have noted (correctly), medtech doesn't work that way. You need a long runway, and the regulatory scene does not favor "move fast and deafen people".
Why would you want to buy anything so important from a startup? Either it'll suck or it'll be good, and if it sucks you don't want it, and if it's good, Google or FB or someone will acquihire the engineers and shut down the product.
Of course whether they'll all just getting steam-rollered by Apple/Google is another matter...
https://www.apple.com/accessibility/
While Apple is arguably ahead in the quality and features of their accessibility technology, the potential convergence of hearing aids and voice based tools means that Google, Amazon and Microsoft are certainly looking into this.
The tech is easy and well-known. Being able to legally sell the product without getting sued? That's hard.
Traditionally, audiology offices undercharge dramatically for their initial consultation and testing, then provide full service for the lifetime of the device. And not just normal electronics service. Often patients will come back every week or two for months to get the fit just right or to get some coaching relearning how to hear conversations or just having the nice lady in the white coat show them how to replace a battery for the fifth time. A lot of clinics will even throw in "free" batteries for life. The cost of all that service ends up getting rolled into the initial purchase price for the hearing aids.
This is dumb. Most audiologists that I know think it's dumb, but it is the status quo. There's a move in the industry toward "unbundled" billing (i.e. charging an hourly rate for services and selling the aids at a much more standard retail markup) that I hope catches on, but it's a hard sell to charge for services that the clinic down the road is providing for "free", even if the total cost of ownership is the same.
I recently went and got my eyes checked, and the doctor assured me that they had low-cost glasses. Their progressive bifocals lenses only started at $300. I pretended to still be interested, then gave an excuse and left.
I purchased some online and got them for less than $100, shipping included. I threw in a regular pair of distance glasses for less than $40, too.
Why is it so much cheaper? Because they can charge it. I'm sure some of the cost is in maintaining staff to help adjust the glasses, and sell them in the first place. But I got my main glasses for less than 1/3 of the prices that they wanted for just the lenses.
Their frames were $100+ that I saw. I'm sure they had some around $50, but that's still more than my entire pair of distance glasses cost.
I wanted to take advantage of my hearing loss to also allow myself augmented, improved hearing for specific scenarios as well. I would love a platform that allows me to do so!
Regardless of the poor quality of the article, the relevant legislation is Over-the-Counter Hearing Aid Act of 2017
https://www.congress.gov/bill/115th-congress/senate-bill/670...
https://obamawhitehouse.archives.gov/blog/2015/10/26/%E2%80%...
- https://www.engadget.com/2017/07/26/apple-cochlear-made-for-...
- http://www.hearingreview.com/2017/08/president-trump-signs-o...
- https://www.nytimes.com/2017/06/12/health/hearing-aids-congr...
- https://www.technologyreview.com/s/608597/how-your-apple-wir...
I've been following it, and it all looks rather interesting. I wonder what changes we'll see soon.
My nephew (3) was just given the Nucleus 7 cochlear implant and my sister says it's great. She can tell all sorts of things - how much he's heard, where it is, and all that jazz - including wireless streaming to the device from an iPhone.
Not everything is something you can throw some Arduino parts and Python code at, contrary to what half of HN seems to think some times. This isn't to say that prices are not ridiculously high, but at the end of the day, they are a medical device that require a trained professional to tune.
Source: worn hearing aids since I was 3 years old.
Maybe it's not a racket, but they're trying awfully damn hard to make it seem like one.
If patents tuned it themselves, they would have too little gain at high frequencies since they may not have heard these frequencies in years and think they sound unnatural. It takes a while to become "used" to hearing aids because patients haven't heard the usual sounds of life like paper rustling in years.
People who think that hearing aids can be replaced by a $200 in-ear amplifier don't understand the domain they're talking about, but there's still much that could be disrupted within this space.
And there's the whole counseling aspect of telling someone they (or their child) has a hearing loss.
And pediatric hearing loss is a fraction of all hearing loss patients... don't make the perfect the enemy of the good ;)
The ability to program the HA per user is not really difficult and in today's world should not even need a direct person it should be able to be done directly.
I personally feel amplification should be done on the phone, good ML algorithms utilized there depending on the ambient sounds and then transmitted to bluetooth HA.
If an industry can make near invisible bluetooth HA they will unlock a huge market
That's incredibly high. Even Best Buy's overpriced warranties aren't that expensive.
Insane.
The one hearing aid scenario is problematic for any sort of headset. If I use earbuds, I can only hear well in one of them. If I were to spend the extra money to get the bluetooth accessory, that would only go to the ear with the hearing aid.
I'd love to be able to input my audiogram into my phone and have it adjust the headset amplification at various frequencies in each ear accordingly.
Even better would be for noise cancelling headphones to be able to also use an audiogram to have the headphones act as hearing aids when not in noise cancelling mode.
First world problems, I guess?
(The place I worked at many decades ago used to be an agent for one of the major hearing-aid companies.)
If you're interested in real-time audio effects on smartphones, AudioGraph is an app I've been playing with.
http://zerokidz.com/audiograph/Home.html
It lets you listen to input signals through the iPhone microphone, do some effects, and pass the output to headphones.
With the right hardware, it's also possible to turn the iPhone into a wireless mic using a Bluetooth headset adaptor (e.g. Sony MW600). Plug the MW600 into the speakers, plug a Kokkia Bluetooth transmitter into the iPhone, run AudioGraph, and speak into the iPhone mic. There's a little lag, but it works well enough for me.
I expect that when my hearing gets worse, I'll use regular headphones (maybe custom-molded Ultimate Ears UE4s) with my iPhone, and do the "tuning" effects using AudioGraph. Being able to pass my smartphone to someone so they can speak into it like a microphone would be much easier than having to lean over so a hearing aid could be closer.
I go to concerts to mosh, buy signed CDs/T-shirts/posters/pins, and meet other fans.
Meeting people requires talking. Earplugs, like the headphones I wear in the office, are a social signal to tell people "don't talk to me". I'm well aware of the dangers to my health, but I've met too many good friends at shows to stop trying to socialise with people who obviously share something in common (taste in music). I'm shy around total strangers, so it's at common-interest events like concerts where I have a starting point to talk about, and thus meet people.
Interesting that you see it this way. I usually always wear custom-moulded earplugs at concerts, and I've never intended or encountered this signaling.
Have you considered high-fidelity custom earplugs? They're rather inconspicous and the sound is much less muffled than with plain old foam plugs. You can carry on a conversation with them, though obviously not as easily as without. I had some made probably a decade ago and they're still going strong. You can get different filter strengths too.
https://www.etymotic.com/consumer/hearing-protection/erme.ht...
That's a hell of a sacrifice to make based on something that's almost purely your imagination. You can have custom earplugs made for $140 that are clear and almost unnoticeable, which will block the majority of damaging frequencies while still allowing you to hear talking pretty well. I promise, no one is going to stop talking to you when you have them in.
The isolation I've experienced from hearing loss is so profound and damaging that it's painful to see how casually you treat it. I'd pay any amount of money to get my hearing back.
"...Experts don’t know exactly why hearing aids are still so costly..."
So the article headline poses a question that writer confesses in the second paragraph not to know the answer to. No, strike that. The author claims that experts don't know the answer to that.
And I scan HN and get answers almost immediately.
HN is great, no doubt, but it's not HN. This is an author who doesn't know how pricing works and doesn't know how to talk to people about how pricing works, which is much more troubling. And the editors must feel that this is the normal state of things.
Pricing may be a bit of a black art in certain markets, but it's no mystery unsolvable by experts. You can bet somebody is setting prices on these things, and when they set them there's a lot of market and historical data being used to do so.
There are simply not-so-many reasons why some things are priced much higher than other things, and these reasons are all well-known and understood. When I read articles like this, it makes me much more critical of every other NYT times article that involves "experts".
Great article for HN because it involves startups, markets, new business opportunities, tech, and so forth. Not such a great article for the NYT, sadly.
http://www.solarear.com.br/ (There is an english version, just click the british flag closer to the footer)
"Solar Ear manufactures low cost, solar rechargeable and environment friendly hearing aids so you can hear perfectly again. Our products are manufactured by deaf workers with high quality components."
Hearing loss runs in my family. When it's time for me, I plan to roll my own. I suspect that if you get rid of just one requirement, it becomes easy. That requirement is to stuff the whole thing in your ear. If the electronics can be in a separate box (or in a smartphone as mentioned), then analog, signal processing, and battery power all become trivial.
https://photos.app.goo.gl/4lOwfrVJ3bfRWkEm1
(Stereo mics and amp with two-channel parametric EQ on each side. About 6" wide and runs on two 9v batteries, if you're curious!)
He took it to a Bose showroom to compare it to their Hearphones. All (Bose people included) agreed that his amp and EQ was superior. Cost for parts is ~$200. He's had a lot of fun building them for himself and his friends.
One set of keywords that seems to turn up some of the limited info out there is "cochlear body worn processor".
Current material refers to 'bodyworn' for babies and toddlers who tend to lose BTEs. You get the same BTE, but it's strapped more firmly to the body.
Reasons
- better quality - the good ones are small computers that use very little power and try to pick out voices from background etc. Apparently the challenging bit for him is dinner parties where you are trying to hear one voice out of several people talking.
- it includes an Audiologist - he's 87 and needs a bit of help on the tech side
- I guess he has the money and values hearing more than the 2k.
It would be cool if computer analysis could understand the several conversations at the party and you could click on the one you wanted or point that way or similar. Maybe in the future, probably won't be cheap.
Also the hardware is not really very cheap either, you have to insert it deep into the ear, and the microphone should be sensitive enough to capture all kinds of sounds, at at all distances and air conditions, removing noise, etc. Microphones have always been expensive. It also would be running 24/7.
But to be honest, price should drop indeed. But everybody knows that everything relative to health will often be overpriced if not regulated, especially if it involves any sort of technology.
How much is a band-aid? Oh, technology. Ok, how about a digital thermometer?
I think the problem is the opposite. Lots of regulation, however benefits they bring, will raise prices and discourage outsiders from offering competitors.
From the article:
"[A new law] includes a provision for selling hearing aids over the counter to adults with mild to moderate hearing loss in two to three years. [...] Under the new law, hearing aids are expected to cost around $300 or less per ear."
This seems to imply that today, and for the next two years, you cannot legally sell a competing, cheaper aid unless you can get doctors to recommend it. Even if it's just as good, it will take a large marketing effort to show it to doctors.
Now, these regulations do bring benefits. But let's not lose sight of their costs.
I'm hopeful this will change. I know a fair number of people around 30 with mild hearing loss, and one who does wear a hearing aid. A history of dangerous headphone volume among my cohorts will probably exacerbate things. Ideally hearing aids would carry no more of a stigma than glasses (FSVO "ideal" :P ).
I wonder if coming up with a earpiece-with-smartphone like combo can be a solution? So the main device with the battery and signal processing SOC is separated from the earpiece. This main device can live in a pocket or attached to the user's belt, while connected to the earpiece through wire.
Perhaps no the most convenient solution, but would it be possible to make such device available cheaply off the selves?
People should still go see an audiologist to properly characterize their hearing loss and use that knowledge to choose a suitable product. There are a lot of hearing aid alternatives already out there, but they cannot be marketed to people with hearing loss until the new law takes effect.
If no one paid for car repair out of pocket, prices would be much higher.
Sources: http://work.chron.com/state-requirements-auto-mechanic-30132... http://www.michigan.gov/sos/0,4670,7-127-49534_50302---,00.h... https://en.wikipedia.org/wiki/Automotive_Service_Excellence
I assume that people in the US are probably tired of "grass is greener on the other side" stories, but I'm seriously surprised that the paid insurance doesn't cover.
Here, the free public health insurance covers the devices needed with no price limit, and cover all battery expenses for life. If you want to get the devices themselves from the private sector, the public health insurance covers up to some fixed price, with you paying the rest.
A clever statement, but do you mean it seriously? Is there some basis for it?
Looking at healthcare and drugs, they cost around a third less in countries with national healthcare than in the U.S., where most healthcare is paid for by individuals or by their employers.
Also, as other people have said, they are expensive because they are technologically advanced and expensive to manufacture. You can build some kind of hearing aid for less than $100 but it will not compare with a $500 one.
I imagine the same applies for hearing aside
http://entcolumbia.org/world-s-first-gene-therapy-trial-hear...
Also promising is a solution using Crispr
https://www.technologyreview.com/s/608899/the-easiest-place-...
While it is not a premium hearing aid, it appears to be adequate for at least some.
Unbranded Chinese hearing aids are available for around $25.
These ridiculous hearing aid companies are going to go the way of dinosaurs soon. And good riddance.
* "Free" meaning "paid for by the tax-sponsored public health insurance", which people up here would call "free".
> In Scandinavia, hearing aids (with a lifetime supply batteries) are supplied without additional cost as part of the national health care program.
> Experts don’t know exactly why hearing aids are still so costly, except that companies continue to invest in improvements, and fees usually cover the services of a highly trained audiologist.
Also, for something as life-transformative as a high quality modern hearing aide, the prices didn't strike me as outrageously expensive.
And the point of the Dr. visit is to tell you if your hearing loss requires a hearing aid, or is just the result of wax buildup.
So...basically, the Dr. visit could be replaced with a Q-Tip.
Maybe each pair of hearing aids results in $6,500 worth of audio research, but if so, I think those researchers may not be a great return on that money.
It's a matter of time before Apple's Ear Buds, come with a $200 hearing aid upgrade.
http://www.sciencemag.org/news/2017/01/no-more-q-tips-your-e... . Or if you prefer video, https://www.youtube.com/watch?v=cYqeUJda2Qs
Earwax is a natural antibacterial mechanism, like mucus. If your ears are fucked up they do sell Debrox kits with a compound to soften it and an irrigation bulb, use those. The irrigation does a number on your ear's protections too though.
When I went to an audiologist and ENT before getting my hearing aid, I had to pay a copay and my insurance company payed thousands (ENT ordered an MRI). A hearing aid from that audiologist would have been at least $3000.
I went to Costco and got an equivalent test with mostly the same audiogram for free. The hearing aid there was $800. I have gone back for free adjustments.
Let's compare this to getting an eye exam and glasses (for both eyes!)
https://www.google.com/search?q=audiologist+salary $74,890
https://www.google.com/search?q=optometrist+salary $103,900
My most recent eye exam plus glasses (after insurance) was way less than $100. The no-insurance no-coupon price on the same would have been about $300. I spent about as much time with the optometrist as I did with the audiologist for the exams. The key difference is the fitting of the hearing aid was done by the audiologist but the fitting of the glasses was done by an optician (salary about a third of an optometrist's salary).
The optometrist also has lots of specialized equipment. The optometrist also has lots of inventory (maybe 1000 frames?) because glasses are a fashion thing too. Audiologists just need to have samples and perhaps a week's worth of inventory. The audiologist's inventory seems more likely to be sold before payment to the supplier is due.
* CostCo has a proud reputation for using their annual membership fees to provide door-buster prices.
* Salary is a coarse and incomplete proxy for the cost of an audiologist visit.
* I see no justification for comparing ear exams to eye exams. Why not proctology?
* You seem to imply that doctors pay cash out of pocket for their medical inventory, instead of operating more like a car dealership, where inventory is held on credit
No, they limit margins and costs (e.g., by limiting SKUs) to keep prices down; paid memberships build psychological attachment, but the $55/yr membership isn't paying for much in terms of lower prices.
And they attribute their revenue to the membership fees.
No, their profit is largely attributes to membership fees; their revenue is almost entirely sales (for the 53-week “year” in their most recent 10-K, $126+ billion in net sales, less than $3 billion in membership fees.)
Basically, Costco uses a giant near-zero-profit sales operation as a the key benefit to sell memberships, which are its profit-making business.
Sure, salary is an incomplete proxy. Each also requires a bit of real estate, support staff, and equipment. Both my optometrist and the Costco vision center have a larger space than the Costco hearing center. The Costco hearing aid area typically has one assistant (not an audiologist) working. The optometrist also has at least one assistant (optician).
I chose eye exams and glasses because it is probably an experience that more people can relate to. Proctologists are MDs ($389,700/yr), have more complex facilities and equipment, need more support staff (reception, nurses, aenesthesiologist), have more complex sanitary needs (proctologists perform surgery), and tend not to send patients home with custom-fit devices.
As for inventory - it very well could be that an optometrist does not pay for it up front.
Fuck Magic Leap, surly enhancing hearing is easier and cheaper.
Block traffic. Enhance birds. Perhaps translate. Listen to tv how I want.
AirPods is the closest you can get right now.
I've considered buying Resound wireless HAs for that purpose before. Instead I just walk around with IEMs and push-to-hear mic all day.