Why Can't Industry Design an Affordable Hearing Aid?

[Sionyn]

"Tricia Romano writes in the NY Times that over the last 10 years, purchasing a hearing aid had become even more difficult and confusing than buying a new car and almost as expensive. 'I visited Hearx, the national chain where I had bought my previous aids. There, a fastidious young man spread out a brochure for my preferred brand, Siemens, and showed me three models. The cheapest, a Siemens Motion 300, started at $1,600. The top-of-the-line model was more than $2,000 for one ear. I gasped.' A hearing aid is basically just a microphone and amplifier in your ear so it isn't clear why it costs thousands of dollars while other electronic equipment like cellphones, computers and televisions have gotten cheaper. Russ Apfel, an engineer who designed a technology now found in all hearing aids, says there is no good reason for the high prices. 'The hearing aid industry uses every new thing, like digital or a new algorithm, to raise prices,' says Apfel. 'The semiconductor industry traditionally reduces the cost of products by 10 to 15 percent a year,' he said, but 'hearing aids go up 8 percent a year annually' and have for the last 20 years."

http://well.blogs.nytimes.com/2012/10/22/the-hunt-for-an-affordable-hearing-aid/

[IanB]

You need to append "in the USA" to your question.

In other parts of the world where governments are involved in healthcare provision they set reasonable price mandates on vendors to prevent artificial price inflation. But in the USA the government has various kinds of "medical device" legislation that sets testing and liability requirements to help make things more expensive, and allows manufacturers to collude with insurance providers to inflate prices as much as they can.

[EEVblog]

Don't modern hearing aids have some form of advanced DSP in them?
And possibly an ASIC to get the size down in modern devices?

Dave.

[IanB]

Maybe they do have complex electronics, but so do cell phones. I don't see why one should cost vastly more to design and manufacture than the other?

[mikeselectricstuff]

Don't modern hearing aids have some form of advanced DSP in them?
And possibly an ASIC to get the size down in modern devices?

Dave.

Yes, but they make enough of them that the NRE won't be a big part of the cost

[Psi]

Yeah, modern hearing aids can be very advanced with DSP/ASIC for all sorts of filtering and intelligent signal processing.
Some have bluetooth pairing to your phone for phonecall audio and so you can adjust a vast amount of settings for audio gain, volume and filtering by using an app.

I think they may do advanced beamforming as well, using multiple microphones to track the locations of sounds and amplify the voice of someone in front of you but not ambient noise.

[poptones]

WHAT?

[prenato]

Even in Europe, my family tells me these devices are very expensive, so I wouldn't say it is just an issue in the USA.  Also I suspect they are substantially more complex than "just a microphone and amplifier in your ear" (I once interviewed for a job at a company that made these; seemed more complex than that:) . That said, the price does seem a bit out of proportion for what they do,  considering complex devices like cellphones are so cheap these days for example. We need some Chinese companies to enter this market to see some competition (maybe they have already?)

[george graves]

From what I understand, the same is true for wheelchairs - over charging.  There a special place in hell of the guy who got insanely rich off of people that lost the use of their limbs.

[tom66]

Same for mobility scooters -- I saw one entry level model with an RRP of £2,500! It's just a pile of lead-acid batteries, a motor, and a chair, in essence. Oh, and it was made in China, like all good things.

[LEECH666]

WHAT?

I chuckled a little. Guess I am going to hell. 

[Conrad Hoffman]

IMO, it doesn't matter what they do, the volume is high enough (no pun intended) that they shouldn't cost more than $100USD... per pair! With DSP and whatever else you want.  A total rip off and insurance doesn't even cover 'em.

[NiHaoMike]

Maybe start an open source project? If we use the pocket radio/MP3 player/cell phone type form factor, it shouldn't be very difficult. Have it operate from standard AA cells and use a low power processor like the EnergyMicro ARM chips. It would also help if it had uses besides a hearing aid such as an electronic stethoscope or guitar effects unit.

[GEuser]

You'll notice in the society databases that when a cheap but good hearing aid actually gets developed that the Divorce Rate will go up dramatically , so there might be a bit of a conspiracy going on 

[sacherjj]

The ones that dad got over 5 years ago were small enough to almost hide in the ear.  They were able to measure the loss of hearing across the frequency band and tailor the amplification to match the loss in the ear.

This was done by programming the device.  So there is some type of custom DSP with configurable gain and feedback detection and avoidance.  Really cheap hearing aides can overload and get into a feedback loop loud enough that you can head the squeal if you are close. 

[jeremy]

Medical device certification is ridiculously, stupidly, ridiculously expensive. Companies like Siemens have to pay this and it is a significant barrier to entry for smaller competitors, so prices rarely come down unless there is a revolutionary new technology. This certification process makes it pretty difficult to do open-sourcey stuff too. I'm not saying the regulation should go away (it is very important), but it does cost a ton.

In their defence, I know that elsewhere in medical devices some things are designed with the intention that insurance companies will be paying, not necessarily the end user directly so they prioritise functionality rather than price. Given the economics of these devices, it seems as though it is either assume that insurance will pay or don't build the device at all. If Siemens made a crappy but cheap hearing aid (which somehow got through certification) and people started getting hit by cars because they couldn't hear them, you could run that entire multinational company into the ground in a few weeks (esp. in the medical litigation environment of the USA).

So the priority is to make the best device possible and worry less about the price. And as mentioned earlier, lots of NRE in these things and not enough buyers.

[poptones]

Taadaa! The world's first open source hearing aid.

[RJSC]

Basically "everything healthcare" is overpriced.
Why does ECG machine cost more than a digital storage oscilloscope?
Is has a good differential amplifier, but than the sample rates are low, and the LCD and processing board are the same or cheaper...

The answer is simple, everyone working in healthcare, be them the chemists/pharmaceuticals, medics, ans EE's who design healthcare devices think they have the right to line their pockets just because it's for your health and you'll pay or die: it's like selling water bottles at 50$ in the middle of the desert...

Here every medic charges 60€ plus for a private appointment which lasts 5 or 10 minutes, and they are VAT free...
You can get an appointment for a tenth of that on the public hospitals, but it takes 1 or 2 years to get to your turn on some specialties and 1 to 3 months where the waiting list is shorter. This is because medics do not want to work on the public sector since they charge on 10 hours of private appointments the same the public sector pays them for a month.

[poptones]

http://youtu.be/wshyX6Hw52I

[Mechatrommer]

audiophoolery has been discussed extensively in this forum so why wonder?

[jeremy]

Why does ECG machine cost more than a digital storage oscilloscope?
Is has a good differential amplifier, but than the sample rates are low, and the LCD and processing board are the same or cheaper...

This I have actual, personal experience with. Not saying there isn't price gouging, but to assume that everyone is just trying to rip off sick people is a bit hyperbolic. Also, an ECG is not the same class of instrument as a hearing aid.

1. Because end users aren't meant to buy them (and shouldn't). One shouldn't use them outside of a specially designed environment as the noise floor will be too high for diagnostic purposes.
2. They absolutely cannot break and absolutely cannot get things wrong. In an ICU you want to worry about people, not whether the soldering on op amps was good enough, or a person vomiting on it will short it out. Liability is HUGE.
3. Thought certification was expensive? Try getting certification for a piece of emergency equipment.
4. Cal is expensive (cal people have their own certifications too)
5. Modern processing algorithms are complicated, especially in diagnostic systems (lots of DSP for noise, wavelet, HMM, NN, etc).
6. (sucks, but true) A reliable ECG readout can potentially clear a clinician from malpractice (saves $$$$$$$). See point 2.

I can build an ECG for less than $20, doesn't mean it should be used by a doctor or in a hospital. But really, you can get a solid ECG for about $10k-20k. This is definitely in the price range of a mid-range digital storage scope? The rigol/siglent/etc is hardly a piece of medical diagnostic equipment, I don't think you can really compare them.

Think medical is expensive? If I told the optics guys I know that I wanted to buy a $20k DSO they could probably just give me the money from spare change out of their pockets

[HackedFridgeMagnet]

Think medical is expensive? If I told the optics guys I know that I wanted to buy a $20k DSO they could probably just give me the money from spare change out of their pockets

where do I meet these 'optics guys'?

[SeanB]

Most of the cost is the markups and testing/certification in the chain in my guess. Low volumes ( 100k units a run per model, versus 100 million a year for a cheap cellphone) and the need to custom encapsulate each one for the user will make them pricier. Ultra low power and ultra small size will also drive the price up as you need to package the interior origami style on a flex PCB, and you will have to supply an expensive low volume programmer/ hearing analyser with every 100 units or so. Has to run for a day or 5 on a single zinc air battery of 30mAh or less capacity, no rechargeable cell is small enough to fit.

This probably will push the per unit cost up to around $100 at the manufacturer, the rest being distributor, retailer markups and cost of certification per country and per healthcare provider ( they vary hugely across the world and from area to area).

BTW, low cost Chinese made orthopaedic equipment is coming into the market, wheelchairs, walking aids and such, quite well made and very cheap, and not subsidised ( which makes them more expensive for some reason) with prices for a frame being $20, crutches $10 and a wheelchair being under $100, the mobility scooter is the most expensive, $500, including charger, batteries and delivery from the local distributor.

[jeremy]

Plenty of places: http://www.cisco.com/, http://www.alcatel-lucent.com/, http://www.huawei.com/en/, etc. Bits and bytes gotta get through the ocean somehow.

[EEVblog]

IMO, it doesn't matter what they do, the volume is high enough (no pun intended) that they shouldn't cost more than $100USD... per pair! With DSP and whatever else you want.  A total rip off and insurance doesn't even cover 'em.

Sure, there is likely some "whatever the market will bear" pricing happening, but I suspect the volumes aren't that huge in the scheme of things.

This site says there are 1.5M sold per year (presumably in the US)
http://www.eldoradohearing.com/faq.htm

WHY DO HEARING AIDS COST SO MUCH?
Some of the reasons hearing aids cost so much are: 1. They are sold in a relatively low volume. Approximately 1.7 million hearing aids are sold per year. Compare that to how many TV sets or computers are sold per year. There is at least one TV set per household and a significant number of computers per household and per business.. 2. The amount of time and money spent by manufacturers on research and development is considerable. One manufacturer claims to have spent over twenty million dollars developing a single model of hearing aid. 3. The amount of time spent by an audiologist with a patient is very significant. Data indicate that an average of five direct contact hours is spent during the first year a patient receives a hearing aid. This time is critical for the success of the fitting and for acclimatization for the new user.

Dave.