Hearing Loss and Healthy Aging Workshop Summary (2014) / Chapter Skim
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4 Current Approaches to Hearing Health Care Delivery
4 Current Approaches to Hearing Health Care Delivery
Pages 31-42
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Today, the traditional system is being supplemented by sales over the Internet and through big-box stores, telemedicine, and direct-to-consumer advertising. Three speakers at the workshop examined the hearing health care system in the United States and abroad.
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In addition, external factors such as noise and reverberation or echoing can obscure speech sounds and affect how well hearing aids and other devices work in a given environment. Reverberation off walls and other surfaces, for instance, can create a great deal of difficulty for listeners.
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In the former category, most people with mild to moderate hearing losses can be effectively helped through the use of hearing aids. Fitting a hearing aid is not a simple process, Chisolm reminded the workshop participants.
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Hearing aids provide limited help for most people with more severe to profound hearing impairments. Cochlear implants, however, which bypass the defective cochlea of the ear and directly stimulate the acoustic nerve, provide a very efficacious intervention, said Chisolm.
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Providing information and counseling about communication strategies can be helpful even for those with mild hearing losses who might not be ready to use hearing aids or other forms of personal amplification. Another type of aural rehabilitation involves listening or auditory training.
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Many stakeholders are involved in the hearing health care system, including the following: • Consumers and their support associations • Health care providers • Hearing health care providers • Industries and manufacturers • Centers for Medicare & Medicaid Services (CMS) • Other health care payers • Legislators and other policy makers • Public health professionals The Healthy People 2020 goals for hearing and other sensory or communication disorders2 include the following: • ENT-VSL-3: Increase the proportion of persons with hearing im pairments who have ever used a hearing aid or assistive listening devices or who have cochlear implants 2 See http://www.healthypeople.gov/2020/topicsobjectives2020 (accessed July 8, 2014)
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Preventive Services Task Force, between 40 and 86 percent of health care providers admitted they did not screen routinely, with barriers noted including a lack of time, the perception that there are more pressing clinical issues, and a lack of reimbursement (Chou et al., 2011)
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The PACE model is based on the On Lok Senior Health Services model started in San Francisco, California, in the early 1970s.3 Such programs could deal with a patient's greatest needs, including hearing, without worrying about reimbursement issues. The bottom line, said Wallhagen, is that the hearing health care system 3 See more about the PACE program at www.npaonline.org (accessed May 9, 2014)
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Wallhagen called for studies that would generate data on the benefits of primary screening and the effectiveness of hearing aids on outcomes and would evaluate models of care that may be targeted to individuals with varying levels of hearing loss. In addition, she said, programs are needed that address the following goals: • Inform older adults about hearing loss, available options, and how to be educated consumers when seeking treatment; • Educate health care practitioners (including physicians, nurses, and physician assistants)
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"You would rather have cell phones, refrigerators, TV sets, and the like." The use of hearing aids varies widely within Europe, Bisgaard observed, from a high of 56 percent of the hearing-impaired adult population in Denmark to single digits in many countries of southern and eastern Europe. The general standard of living among countries accounts for some of these differences, he said, but so do differences in accessibility to hearing health care, subsidy levels, and general historical factors.
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Its scope is for typical age-related losses, and it acknowledges that children, cochlear implants, and multiple disabilities require further efforts. A country-by-country analysis by Bisgaard revealed that subsidies for hearing health care and hearing devices increase hearing aid use.
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The bundling of services into hearing aids might also change, though this is a "delicate matter," Bisgaard said. But "it is inevitable that it is going to come up some day and that we need to work with that dimension." People are accustomed to paying for part of their dental and vision services, Bisgaard concluded, and they will likely need to do so with hearing as well, though subsidies will improve their likelihood of moving forward.
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