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Original Investigation
June 2018

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

Author Affiliations
  • 1Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor
  • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 3Department of Physical Medicine & Rehabilitation, School of Medicine, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2018;144(6):498-505. doi:10.1001/jamaoto.2018.0273
Key Points

Question  Is the use of hearing aids associated with the probability of hospitalizations and emergency department visits as well as health care use and spending among older people with self-reported hearing loss?

Findings  In this cohort study of nationally representative data from 1336 US Medicare beneficiaries who reported hearing loss, self-reported use of hearing aids was associated with reducing any visits to the emergency department and hospitalizations, both by means of 2 percentage points. Use of hearing aids increased the number of office visits, if any, by 1.40 days and reduced the number of nights in the hospital, if any, by 0.46 nights; hearing aids also increased total health care spending by $1125 and out-of-pocket costs by $325 but decreased Medicare spending by $71.

Meaning  This information might be useful for the Centers for Medicare & Medicaid in deciding on insurance coverage of hearing aids for older adults with hearing loss.

Abstract

Importance  Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.

Objective  To determine whether HA use is associated with health care costs and utilization in older adults.

Design, Setting, and Participants  This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.

Exposures  Encounter with the US health care system.

Main Outcomes and Measures  (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.

Results  Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, −$81 to −$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, −2% to −2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, −3% to −1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, −0.47 to −0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).

Conclusions and Relevance  This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

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