One word: Regulation.  Here’s the scoop:

In 1977, the Hearing Aid Rule was passed by the Food and Drug Administration to set up boundaries of who can sell hearing aids.  The rule was passed to protect consumers from aggressive sales people who were selling hearing aids to people that didn’t need them.  In several reported cases, people with hearing loss had medical issues like infections, nerve tumors or excessive ear wax, and didn’t need hearing aids.  The FDA felt that requiring a medical exam prior to purchasing hearing aids would eliminate these abuses.

This meant that only two groups of people could sell hearing aids:  a state-licensed hearing aid dispenser and audiologists.  State-licensed dispensers have to prove their competence to administer hearing exams, fit devices and recognize underlying physical problems and are required to have a high-school diploma. Audiologists must have at least a master’s degree, though they generally aren’t medical doctors. After the FDA rule went into effect, audiologists changed their professional code of ethics and began to sell hearing aids.

So now, we have a tightly controlled distribution system of who can sell hearing aids.  The excuse that these groups use in charging high prices for hearing aids is the education, testing and regulations required to do so.  This reason does not sit well with many hearing aid consumers.  In fact, the high cost prevents many people who need hearing aids from purchasing them (only one in five people that need hearing aids, get them, according to BHI).

But there is more to the story.  Both sides of the discussion have points that are easy counterbalanced by the other.

Why they say the price is justified:

• Hearing aids are extremely small, very complex little instruments that do not have the economy of scale that other small, complicated electronic devices do. (Hearing aids have a 2% market penetration, compared to +70% for cell phones.)
• Under standards set by professional bodies, the specialists must pass a battery of tests and fitting sessions, which then drives up the cost.
• In most cases, the purchase of the hearing aid also covers all maintenance and adjustment appointments (for the warranty period).
• The cost of the hearing aid funds research and development for better technology for hearing impaired people.

Why others say the cost of hearing aids is a rip-off:

• You can go over to your local hunting goods store and find active hearing protection that hunters use for under $100.  These have even less economy of scale than hearing aids.  The technology costs a few hundred dollars, the rest is in distribution.
• The idea that new technology from R&D is making significant strides is ridiculous.  There will be some advancement made, sure, but if hearing aid manufacturers really were introducing a new feature or circuit every year, we should expect to have super-human hearing with our hearing aids.  Who do you know who feels this way?
• The concept of private labeling has been introduced to the hearing aid industry.  A company, like Costco, for instance, can purchase bulk hearing aids and label them with their own brand.  If there is not lots of money to be made, why would they do this?  This is a clear indication of big profit margins.
• And speaking of profit margins, the fact that there is no transparency for consumers on how much a hearing aid costs at the wholesale level and how much the audiologist or the specialist is making on the sale makes it very difficult to trust that there is not a significant mark-up.

Which begs the question:  What can we do about it?

The most important thing that hearing aid shoppers can do is shop around.  Interview several different Audiologists and Specialists until you find one you like (start with a recommendation from your doctor).  Compare the different offerings and hearing aids types they recommend.  Understand the warranty included with each.  Look for sales.  Use alternative channels like mail order and the internet in return for lower prices.  When ordering online or through a catalog, but sure to check out the reputation of the company and get a clear understanding of their return/replacement policy.

The second thing to keep in mind is that you don’t have to buy the most expensive aids on the market to get the best quality of life.  Paying more does not guarantee that you will hear noticeably better.   The key is to get a specialist or audiologist that you trust (see above) and talk with them about your budget and your life style.  A good hearing aid dispenser will spend time with you to find an aid that will work.  If they don’t ask questions like these, or spend time talking with you, get up and leave.  Find another dispenser to work with.

The key in getting the perfect hearing aids at the right price is research.  Do a lot of it and you will find something that will make you happy.  Don’t forget to recognize the profound impact that well-fitted hearing aids can have on the lives of hard of hearing people.

But, we still think they are too expensive, don’t we?  If you think that removing the regulation that governs who can sell hearing aids is a good idea (here are two interesting articles on the subject), call the FDA and tell them your concerns.  Beyond that, there isn’t a clear cut way to have an impact on this issue.  I will continue to do research and keep you posted.  I would love to hear your comments and suggestions below.

Happy hearing!