National Academies Press: OpenBook
Suggested Citation:"Front Matter." 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.
×

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

Images

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

Suggested Citation:"Front Matter." 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.
×

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.

Suggested Citation:"Front Matter." 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.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." 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.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." 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.
×

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

Suggested Citation:"Front Matter." 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.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." 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.
×

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

Page viii Cite
Suggested Citation:"Front Matter." 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.
×

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.

Suggested Citation:"Front Matter." 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.
×

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

Suggested Citation:"Front Matter." 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.
×

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

Suggested Citation:"Front Matter." 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.
×
Suggested Citation:"Front Matter." 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.
×

This page intentionally left blank.

Page xiii Cite
Suggested Citation:"Front Matter." 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.
×

Abbreviations and Acronyms

AAA American Academy of Audiology
ACA Patient Protection and Affordable Care Act
ACL Administration for Community Living
ADA Americans with Disabilities Act
AHRQ Agency for Healthcare Research and Quality
ANSI American National Standards Institute
ASA Acoustical Society of America
ASHA American Speech–Language–Hearing Association

BLSA

Baltimore Longitudinal Study of Aging

BMHS Blue Mountains Hearing Study
BMI body mass index

CDC

Centers for Disease Control and Prevention

CFR Code of Federal Regulations
CI confidence interval
CMS Centers for Medicare & Medicaid Services
CQI continuous quality improvement
CTA Consumer Technology Association
CVAA Twenty-First Century Communications and Video Accessibility Act of 2010

dB

decibel

dB HL decibel hearing level
dB SNR signal-to-noise ratio in decibels
Suggested Citation:"Front Matter." 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.
×
dB SPL decibel of sound pressure level
DoD Department of Defense
DOJ Department of Justice

EHLS

Epidemiology of Hearing Loss Study

EMC electromagnetic compatibility
EPSDT Early and Periodic Screening, Diagnostic, and Treatment (program)
ERISA Employee Retirement Income Security Act of 1974

FCC

Federal Communications Commission

FDA Food and Drug Administration
FDCA Federal Food, Drug, and Cosmetic Act
FM frequency-modulated
FR Final Rule
FTC Federal Trade Commission

HEDIS

Healthcare Effectiveness Data and Information Set

HIPAA Health Insurance Portability and Accountability Act
HHS Department of Health and Human Services
HLAA Hearing Loss Association of America
HMO health maintenance organization
HR hazard ratio
HRSA Health Resources & Services Administration
Hz hertz

ICF

International Classification of Functioning, Disability and Health

IOM Institute of Medicine

kHz

kilohertz

LACE

Listening and Communication Enhancement (program)

NHANES

National Health and Nutrition Examination Survey

NHS National Health Service
NIA National Institute on Aging
NIDCD National Institute on Deafness and Other Communication Disorders
NIH National Institutes of Health
NIOSH National Institute for Occupational Safety and Health
Suggested Citation:"Front Matter." 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.
×
OSHA Occupational Safety and Health Administration
OTC over the counter

PCAST

President’s Council of Advisors on Science and Technology

PMA premarket approval
PQRS Physician Quality Reporting System
PSAP personal sound amplification product
PTA pure tone average

QSR

quality system regulation

RERC

Rehabilitation Engineering Research Center

SE

standard error

UIB

user instructional brochure

USPSTF U.S. Preventive Services Task Force

VA

Department of Veterans Affairs

WHO

World Health Organization

Suggested Citation:"Front Matter." 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.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." 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.
×
Page R1
Suggested Citation:"Front Matter." 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.
×
Page R2
Suggested Citation:"Front Matter." 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.
×
Page R3
Suggested Citation:"Front Matter." 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.
×
Page R4
Suggested Citation:"Front Matter." 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.
×
Page R5
Suggested Citation:"Front Matter." 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.
×
Page R6
Suggested Citation:"Front Matter." 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.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." 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.
×
Page R8
Suggested Citation:"Front Matter." 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.
×
Page R9
Suggested Citation:"Front Matter." 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.
×
Page R10
Suggested Citation:"Front Matter." 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.
×
Page R11
Suggested Citation:"Front Matter." 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.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." 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.
×
Page R13
Suggested Citation:"Front Matter." 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.
×
Page R14
Suggested Citation:"Front Matter." 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.
×
Page R15
Suggested Citation:"Front Matter." 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.
×
Page R16
Next: Summary »
Hearing Health Care for Adults: Priorities for Improving Access and Affordability Get This Book
×
Buy Paperback | $80.00 Buy Ebook | $64.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The loss of hearing - be it gradual or acute, mild or severe, present since birth or acquired in older age - can have significant effects on one's communication abilities, quality of life, social participation, and health. Despite this, many people with hearing loss do not seek or receive hearing health care. The reasons are numerous, complex, and often interconnected. For some, hearing health care is not affordable. For others, the appropriate services are difficult to access, or individuals do not know how or where to access them. Others may not want to deal with the stigma that they and society may associate with needing hearing health care and obtaining that care. Still others do not recognize they need hearing health care, as hearing loss is an invisible health condition that often worsens gradually over time.

In the United States, an estimated 30 million individuals (12.7 percent of Americans ages 12 years or older) have hearing loss. Globally, hearing loss has been identified as the fifth leading cause of years lived with disability. Successful hearing health care enables individuals with hearing loss to have the freedom to communicate in their environments in ways that are culturally appropriate and that preserve their dignity and function.

Hearing Health Care for Adults focuses on improving the accessibility and affordability of hearing health care for adults of all ages. This study examines the hearing health care system, with a focus on non-surgical technologies and services, and offers recommendations for improving access to, the affordability of, and the quality of hearing health care for adults of all ages.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!