HEARING
HEALTH CARE
FOR ADULTS

Priorities for Improving Access and Affordability

Committee on Accessible and Affordable
Hearing Health Care for Adults

Dan G. Blazer, Sarah Domnitz, and Catharyn T. Liverman, Editors

Board on Health Sciences Policy

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project was supported by the Centers for Disease Control and Prevention, Department of Defense (Contract No. HHSP233201400020B/HHSP23337039), Department of Veterans Affairs (Contract No. HHSP 233201400020B/HHSP23337040), Food and Drug Administration, Hearing Loss Association of America, and the National Institutes of Health (National Institute on Aging, National Institute on Deafness and Other Communication Disorders) (Contract No. HHSN26300060). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43926-8
International Standard Book Number-10: 0-309-43926-4
Library of Congress Control Number: 2016946879
Digital Object Identifier: 10.17226/23446

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Hearing health care for adults: Priorities for improving access and affordability. Washington, DC: The National Academies Press. doi: 10.17226/23446.

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COMMITTEE ON ACCESSIBLE AND AFFORDABLE HEARING HEALTH CARE FOR ADULTS

DAN G. BLAZER (Chair), Duke University Medical Center, Durham, North Carolina

BRENDA BATTAT, Independent Consultant, Bethesda, Maryland

KAREN J. CRUICKSHANKS, University of Wisconsin–Madison School of Medicine and Public Health

JENNIFER E. DEVOE, Oregon Health & Science University, Portland

JUDY R. DUBNO, Medical University of South Carolina, Charleston

RICHARD ELLENSON, Cerebral Palsy Foundation, New York, New York

BARBARA J. EVANS, University of Houston Law Center, Texas

ELLEN J. FLANNERY, Covington & Burling, LLP, Washington, DC

DARRELL J. GASKIN, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

WILLIAM R. HAZZARD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

FRANK R. LIN, Johns Hopkins University, Baltimore, Maryland

NICOLE MARRONE, University of Arizona, Tucson

JOSÉ A. PAGÁN, New York Academy of Medicine, New York

THOMAS PIPPIN, Wisconsin Hearing Aids, Inc. (Retired), Walnut Hill, Florida

KATHERINE D. SEELMAN, University of Pittsburgh, Pennsylvania

DEBARA L. TUCCI, Duke University, Durham, North Carolina

DAVID A. ZAPALA, Mayo Clinic Florida, Jacksonville

Study Staff

CATHARYN T. LIVERMAN, Study Director

SARAH B. DOMNITZ, Study Director

CLAIRE GIAMMARIA, Research Associate

JUDY ESTEP, Program Associate

SOPHIE YANG, Research Assistant

ANDREW M. POPE, Director, Board on Health Sciences and Policy

Consultant

ANDREA M. SCHULTZ, Science Writer

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

YURI AGRAWAL, Johns Hopkins University School of Medicine

ANDREW B. BINDMAN, University of California, San Francisco

CYNTHIA COMPTON-CONLEY, Compton-Conley Consulting, LLC

ADRIAN DAVIS, Patron Ear Foundation

HOWARD W. FRANCIS, Johns Hopkins University School of Medicine

PATRICK M. HOLKINS

LARRY E. HUMES, Indiana University

DAVID A. LINDEMAN, University of California, Berkeley

LAWRENCE R. LUSTIG, Columbia University Medical Center and New York Presbyterian Hospital

EDWARD H. LYBARGER

TRICIA NEUMAN, Kaiser Family Foundation

AMEDEO ODONI, Massachusetts Institute of Technology

JAMES T. PACALA, University of Minnesota Medical School

CATHERINE PALMER, University of Pittsburgh Medical Center

WILLIAM H. PRESS, The University of Texas at Austin

STEPHANIE SJOBLAD, University of North Carolina at Chapel Hill

ANDREW SUSSMAN, MinuteClinic and CVS Health

DONNA-BEA TILLMAN, Biologics Consulting

MARY E. TINETTI, Yale School of Medicine

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Nancy Fugate Woods, University of Washington, and Enriqueta C. Bond, QE Philanthropic Advisors. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Preface

For those who can hear, auditory connection to the world is usually taken for granted. Hearing is a complex physiologic process, and when lost or diminished, it can have effects on health, independence, well-being, quality of life, and daily function as well as on everyday communication. This study—focused on improving accessibility and affordability of hearing care for adults—occurs at an opportune time for progress in this field. Hearing technologies are evolving at ever-increasing rates, care is moving into a variety of retail and online settings, and the pricing structures for hearing aids and associated services are being reexamined. Our committee makes its recommendations acknowledging these changes and urging further and immediate action.

The committee grappled with the questions of how and why hearing loss has been relegated to the sidelines of health care. The barriers to access that have been reported include high costs, lack of insurance coverage, the stigma associated with hearing difficulties and wearing hearing aids, and limited awareness of available options. The goals of this report and its recommendations are to increase transparency, expand treatment options, provide the evidence necessary for consumers to make informed decisions about their hearing health care, and examine various health care delivery and payment models. Hearing loss is a significant public health problem that requires actions throughout the health care and broader community.

Our committee’s work greatly benefited from the insights provided by the workshop speakers and feedback from the report reviewers as well as from comments from many others who provided information to the committee. We especially thank the study sponsors for their work on hearing

health and for their support of this study (listed alphabetically): the Centers for Disease Control and Prevention, the Department of Defense, the Department of Veterans Affairs, the Food and Drug Administration, the Hearing Loss Association of America, the National Institute on Aging, and the National Institute on Deafness and Other Communication Disorders.

I am truly grateful for having had the opportunity to work with this dedicated committee which undertook this study with great energy, intellect, and commitment. This was a complex task full of details and nuances, and the committee members stepped up to meet the challenge—so much so that even a blizzard did not stop them—meeting by Web conferencing and then rearranging their schedules to meet in person 2 weeks later. Their level of engagement in the study and their reasoned and thoughtful discussions made this report possible. Committee members balanced their deeply held individual views with the overarching goal of improving hearing health care. We were all fortunate to work with an intrepid and skilled team of the National Academies of Sciences, Engineering, and Medicine staff, and we deeply thank Sarah Domnitz, Cathy Liverman, Claire Giammaria, Sophie Yang, and Judy Estep, led by Andrew Pope, board director. Without their outstanding support, this report would have been impossible. We also thank Andrea Schultz for her writing and editing work and Ellen Kimmel of the Academies library staff for her assistance throughout the study process. The committee greatly appreciates the efforts of Teresa Meyer-Clemens and Deanna Baker in providing captioning.

As noted above, improving communication for individuals with hearing loss was the goal of the committee’s work. It is the committee’s hope that the many organizations, agencies, and individuals working on or interested in hearing health care will find this report a source of common ground from which they can work together to keep moving this field forward.

Sincerely,

Dan G. Blazer, Chair

Committee on Accessible and Affordable
Hearing Health Care for Adults

Contents

Abbreviations and Acronyms

Summary

1 Introduction

2 Hearing Loss: Extent, Impact, and Research Needs

3 Hearing Health Care Services: Improving Access and Quality

4 Hearing Technologies: Expanding Options

5 Improving Affordability of Services and Technologies

6 Engaging a Wider Community: Awareness, Education, and Support

7 Opportunities for Action

Appendixes

A Meeting Agendas

B Committee Biographies

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Abbreviations and Acronyms

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