Provider Perspectives on the Accessibility and Affordability of Hearing Healthcare in Arizona

Abstract

Hearing loss negatively affects the lives of millions of Americans (Lin, Niparko, & Ferrucci, 2011). Amplification can enhance audibility and in turn improve quality of life (Mulrow et al., 1990). Yet it is estimated that only 20% of those who would benefit from amplification in the United States actually utilize it (Chien & Lin, 2012). Discomfort and insufficient value have been cited as reasons for low uptake as well as low motivation, negative attitudes towards hearing aids, and lack self-perceived handicap (McCormack & Fortnum, 2013; Vestergaard-Knudsen et al., 2010). Studies have also attributed the out-of-pocket cost for hearing aids as a substantial barrier (Bainbridge & Ramachandran, 2014; Kochkin, 2000). Cost as a barrier to hearing aid access may be an issue of particular importance in regions with high poverty, as low-income adults are less likely to report hearing aid use (Bainbridge & Ramachandran, 2014). Hearing aids can typically cost about $2,000 each, possibly making them out of reach for individuals living at or below the poverty line. Arizona has one of the highest poverty rates in the United States (Bishaw & Fontenot, 2014). Using US Census data and epidemiologic studies, we estimate that there are approximately 1,145,166 adults over the age of 19 living with significant bilateral or unilateral hearing loss in Arizona. An estimated 204,984 of these individuals are living at or below the federal poverty line (Lin, Naparko, & Ferrucci, 2011; Bishaw & Fontenot, 2014, Muller et al., 2015, US Census). These numbers are particularly alarming, as there are limited resources to support adults with hearing loss in Arizona. The aim of this study was to gather provider perspectives on the accessibility and affordability of hearing healthcare in Arizona. The long-term goal is to develop a state-level initiative to increase hearing aid use among low-income adults. Based on previous research from the Hearing Aid Coalition, we hypothesized that Arizona providers would prefer a state-level plan that mirrors service coverage and reimbursement mechanisms of private insurance (Hearing Aid Coalition, 2004) Audiologists and hearing instrument specialists were recruited via email to participate in focus groups and surveys. Three focus groups were held across the state in Phoenix, Flagstaff and Tucson (n = 26). The survey methodology included open and closed questions and was administered in paper-based and online versions (n = 77). Data were transcribed, coded, and analyzed using descriptive and basic regression analyses. There was wide-ranging participation from providers across the state representing urban and rural practice locations (All 15 counties represented). Data revealed most providers would prefer to see changes in the current state of hearing access for low-income adults. Providers considered a number of factors to be important when developing and implementing changes to existing service delivery. These factors included a centralized entity to distribute referrals across practices and sufficient reimbursement for service providers. Common themes included the need for a balance between quality of care and expense as well as creating a fee-for-service component to invest the patient in the process. Increased philanthropic practice image and fair compensation were cited as the greatest motivations for provider participation. Survey results also indicated that most providers are already doing pro-bono work. This study highlights that providers are willing to participate in state-level initiatives to improve hearing aid access. Ultimately, these results will inform policy makers of provider preferences for mechanisms of service-delivery and reimbursement. This research is a collaborative project funded by the Arizona Commission for the Deaf and the Hard of Hearing.