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MarkeTrak V Hearing Aid Industry Market Tracking Survey. Sergei Kochkin, Ph.D. Knowles Electronics, Inc. June 1999. MarkeTrak Topics. Demographic indices & trends Customer satisfaction revisited Hearing aids in the drawer Subjective benefit. Demographic Indices. - PowerPoint PPT Presentation
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MarkeTrak VHearing Aid Industry Market
Tracking Survey
Sergei Kochkin, Ph.D.
Knowles Electronics, Inc.
June 1999
MarkeTrak Topics
• Demographic indices & trends
• Customer satisfaction revisited
• Hearing aids in the drawer
• Subjective benefit
Demographic Indices
• National family opinion panel
– 80,000 households
– 13,492 hearing-impaired households
• Detailed questionnaire 2,720 hearing aid owners.
• Response rate 83%
• No new survey to non-owners in MarkeTrak V.
Hearing Aid Market Penetration
23.8
22.9 22.6
21.3
20.4
18
19
20
21
22
23
24
25
1984 1989 1991 1994 1997
% P
enet
rati
on
Hearing-impaired User & Non-user Population
0.8 0.7 1 0.9
4.9 5.1 4.6 4.7
19 20 20.621.7
0
5
10
15
20
25
1989 1991 1994 1997
Mill
ions
Non-users Users Non-owners
Hearing Loss Population by Age GroupOwners versus Non-owners
0 1 2 3 4 5
Millions
<18
18-34
34-44
45-54
55-65
65-74
75-84
85+OwnersNon-owners
Clinton Announcement Spurred “Baby Boomer” Potential Market Growth
3
3.5
4
4.5
5
5.5
Mil
lio
ns
34-44
45-54
55-65
65-74
75+
19941997
• Clinton news release 10/97.
• Survey taken 11/97.
• Age 45-54 hearing loss growth =23%
• $60k growth =35%
• Some college growth = 30%
Physician Screening for Hearing Loss During Physical Exam
15.116.3
18.820.2
1816.6 16.6
0
5
10
15
20
25
Perc
ent s
cree
ned
May-89 Nov-89 May-90 Nov-90 Jan-92 Jan-92 Dec-97
HIA Targeting with Physicians
Binaural Penetration Trend
22
37
51 52
60
25
47
6165 65
70
79 79
0
10
20
30
40
50
60
70
80
90
1984 1989 1991 1994 1997
Total Owners
Total Owners - Current
Bilateral loss Ss - Current
Hearing Instrument Fittings by Perceived Profession
0
10
20
30
40
50
60
70
Per
cent
of
fitt
ings
Audiologist Physician H.I.S Other
1984199119941997
Hearing Instrument Fittings by Source of Distribution (1997)
0 10 20 30 40
Audiology office
Hearing aid store
ENT office
VA
Home
Family Dr.
Other
Hospital
Department store
Clinic
Military
% purchases
1997
1994
Perhaps one to watch
Third-party Payment Trend
20.4 22.2 21.116.2
2327.5
0
5
10
15
20
25
30
1984 1984 1989 1991 1994 1997
% o
f sa
les
Average Retail Price to Consumer
0100200300400500
600700800900
1000
Total BTE ITC ITE
Dol
lars
1989199119941997
+24% +11% +30% +12%
Age of Hearing Instrument
05
1015
20253035
404550
% o
f sal
es
<2 yr 3-4 yrs 5-6 yrs 7-8 yrs 9+ yrs
199119921997
Mean age of instruments:
1991 = 3.1 yrs
1994 = 3.7 yrs
1997 = 3.8 yrs
First Time User Rate
53.4
40.5
29
39
0
10
20
30
40
50
60
Per
cen
t of
sal
es
1989 1991 1994 1997
FDA/FTC
Eddie Albert Ads
Factors Influencing New First Time Users to Purchase
• Factors less than 10% mentions:
– Free HA (7%)
– Price (6%)
– Ad-magazine (5%)
– HL Literature (3%)
– Boss/co-worker (3%)
– Newspaper (2%)
– Direct mail (2%)
– Ad - TV (1.5%)
% New users
63
53
26
13111110
0
10
20
30
40
50
60
70
H.L. worseFamilyAudiologistH.I.S.ENTHA OwnerFamilyDoctor
Physician Recommendation Trends
0
5
10
15
20
25
30
% o
f n
ew u
sers
89 91 94 97
Family
ENT
• 1989 - HIA advertising to physician.
• Current initiatives:– Mfg. screening kit– BHI - physician
handbook– BHI - Academy of
Family Physicians– AAA Best Practice
• Family doctor (Positive)• ENT (Negative)
Key Trends
• Negative trends
– hearing aid penetration
• Static trends
– hearing screenings by physicians
– distribution penetration
– Binaural penetration
Key Trends
• Positive trends
– third party payment
– first time users
– repeat purchase
– retail price (??)
– Clinton - motivation of “Baby Boomers”
• 1 million new potential customers
Customer Satisfaction Revisited
Topics
• Trends 1991-1997 (1-5 years old)
• Segmentation (1-5 years old)
• Publishing of new research norms (3-12 months old)
• Hearing aids in the drawer (total)
Method
• MarkeTrak Survey– 4 behavioral items (hours, repurchase)– 1 Quality of life– Likert Satisfaction Scale
• 8 Product features • 12 Performance/value• 13 Listening situations• 6 dispenser attributes
– Modified APHAB (21 point scale = 5%)
Customer Satisfaction by Age of Hearing Instrument
7363 60 59 58 53 53 53
43 42
010203040
50607080
<3 mo. 4-6 mo. 7-12mo.
2 yr. 3 yr. 4 yr. 5 yr. 6 yr 7-9 yr. 10+ yr.
Age of hearing aid
% S
atis
fact
ion
Amount of Time Spent CounselingNew Users of Hearing Instruments
2.611.5
29.423.3 20.1
7 6.10
5
10
15
20
25
30
35
None 0.25 0.5 0.75 1 2 3+
Time spent in counseling (hours)
% n
ew u
sers
Customer Satisfaction as a Function of Time Spent with New Users
13
4555 59 65 68
0
10
20
30
40
50
60
70
80
None 0.25 0.5 0.75 1 2
Time spent in counseling (hours)
% s
atis
fact
ion
Multiple Environmental Listening Utility (MELU) is Critical to Satisfying Consumers
0102030405060708090
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Number of listening situations satisfied
Ove
rall
sat
isfa
ctio
n
Perceptions of Benefit as a Function of Multiple Environment Listening Utility (MELU)
0102030405060708090
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Number of listening situations satisfied
Sati
sfac
tion
(%
) w
ith
Ben
efit
Quantifiable Client Oriented Scale of Improvement (COSI)
• MarkeTrak measures satisfaction in 13 listening situations (5 point scale).– Very Satisfied (+2) to very dissatisfied (-2)
• Also “Importance” of hearing in these 13 listening situations (0-3 point scale)– Not important (0) to very important (3)
• Score = Satisfaction x importance• Total score = Sum (all situations x need)/Total
possible score
Quantifiable COSI - Strong Predictor of Perception of Benefit
0102030405060708090
100
% Very satisfied
-50-100
-1-49
0 10 20 30 40 50 60 70 80 90 100
COSI (% Need Met)
U.S. Customer Satisfaction TrendsNo significant differences (H.A. 1-5 years.)
60 57 59
18 17 15
0
10
20
30
40
50
60
70
1991 1994 1997
% S
atis
fact
ion
PositiveNegative
U.S. Customer Satisfaction New Hearing Instruments (<1 year)
• Declines (+5%)– Battery life– Adjust. V.C.– Value ($$/performance)
• Gains (+5%)– Visibility– Localization– Outdoors– Place worship– Telephone– Post fitting service
66 7163
12 7 100
10
20
30
40
50
60
70
80
1991 1994 1997
% Sa
tisfact
ion
Positive Negative
Customer Satisfaction Trends
• MarkeTrak V significantly higher than:
– MarkeTrak IV (1994) :
• 23 of 33 items (p<.01)
– MarkeTrak III (1991):
• 4 of 33 items (p<.01)
Customer Satisfaction Trends
• Key improvements (1997 vs.1991 & 1994):
– Outdoor enjoyment
– Phone usage
– Value
– Explain care of hearing aids
• Visibility ratings are lower than in 1991
The introduction of CICs Probably Caused Post-purchase Cognitive Dissonance with Visibility of Instrument
62
7379
5760
67
86
30
40
50
60
70
80
90
BTE ITE ITC CIC
% S
atis
fact
ion
19911997
Satisfaction Segmentation
• by type of hearing loss• by style of hearing aid• Programmable/non-programmable • Telecoil• Hearing aids without volume controls• New user versus repeat user• Binaural versus monaural
Overall satisfaction by Style of Hearing Aid
61
58
57
56
66
50 52 54 56 58 60 62 64 66 68
BTE
ITE/Full
ITE/Partial
ITC/Visible
ITC/Invisible
% Satisfaction
Satisfaction by Style of Hearing Aid
• CIC rated superior on 15 attributes.
– Visibility
– Comfort with loud sounds
– Listening situations (7 of 13)
• Telephone, Outdoors, workplace, Groups, restaurant
• CIC rated lower on battery life, V.C.
– 34% w/o a V.C. want one
Satisfaction by Style of Hearing Aid
• BTE rated significantly lower:– Ability to hear soft sounds– Difficult listening situations – Tell direction of sounds
• BTE rated higher– Hours worn– Battery life
• Are lower ratings due to degree of loss?
Customer Satisfaction by Perceived Level of Hearing Loss
48
60
58
66
0 10 20 30 40 50 60 70
Mild
Moderate
Severe
Profound
Deg
ree
of H
eari
ng L
oss
% Satisfaction
Customer Satisfaction by Perceived Level of Hearing Loss
• Mild loss significantly lower on 13 attributes
– Quality of life
– Likelihood of repurchase/recommend HA
– Wearing of aids
– Perception of benefit
– One-on-one communication
Customer Satisfaction by Perceived Level of Hearing Loss
• Profound lower on 15 attributes:– Perceived benefit– Fit and comfort– Ability to hear soft sounds– Localization– Whistling/feedback– Nearly all listening situations
• Yet, they give the highest overall rating.
What about the volume control?
• 9% report they have none.
• 37% want one.• Big differences on
satisfaction.• Should make sure
consumer can live without a volume control.
Overall Customer Satisfaction
82
52 49
0102030405060708090
100
Don’tNeedVC
Notsure
NeedVC
% S
atis
fact
ion
The Binaural Advantage(Rated higher on 15 attributes)
3
14
11
11
9
9
8
8
8
0 2 4 6 8 10 12 14 16
Overall
Localization
Able to hearing soft sounds
Small groups
Outdoors
Car
Sound of voice
Church
Concert/movie
% Satisfaction (Difference score)
The Telecoil Advantage(Rated higher on 8 attributes)
2
18
12
11
10
9
0 5 10 15 20
Overall
Telephone
Whistling/feedback
Quality of life
Outdoors
Recommend HA
% Satisfaction (Difference score)
The Programmable Advantage(Rated higher on 37 attributes)
10
16
16
16
15
15
14
14
13
0 5 10 15 20
Overall
Comfort/loud sounds
Whistling/feedback
Small groups
Place of worship
Warranty
Noisy situations
Telephone
Car
% Satisfaction (Difference score)
New Users More likely to be Dissatisfied with Their Experience
• 54% overall satisfaction new users – versus 63% for repeat users
• New users rate 16 items lower– Quality of life (-21)
– Recommend hearing aids (-12)
– Repurchase , reliability (-10)
– Battery life (-8)
• New users rate 5 items higher– Able to hear soft sounds (+10), Large group (+7)
Key Findings• Modest improvements since 1991• Major improvements since 1994• Strong advantage in favor of
– Programmable– Telecoil– Binaural – CIC
• Mild hearing loss & new users less satisfied
Key Findings• CIC introduction - probable negative impact on
larger instrument satisfaction.
• Lack of a VC could depress satisfaction for some segments of users.
• Importance of:
– Counseling time spent with consumer
– Multiple environmental listening utility (MELU)
– Volume control to some users of CICs
Hearing Aids in the Drawer
Methodology
• Consumers who own a hearing aid but NEVER wear it = hearing aid in the drawer.
• Hearing aids in drawer = 16.2% respondents.
• Told to explain why non-use in MarkeTrak survey.
• Received 348 letters.
• Content coding yielded 567 comments.
Hearing Aids in the Drawer are Related to Age of the Instrument
5 8 14 15 20 23 20 29 36 320
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10+
Age of hearing aid (years)
Per
cent
in d
raw
er
907,120 Customers do not Use Their Hearing Instruments
0
20
40
60
80
100
120
Volume (000)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age of hearing aid (years)
325,000 1-4 years
Reasons for Non-Use
• Poor benefit (30%) - 268,507
Reasons for Non-UsePoor Benefit
• “I threw it away it was worthless to me”
• “I don’t see much difference with them. I feel I was sold one under false pretense. Don’t feel I really needed one”
• “There is no improvement in my hearing with the aids. Where there is a slight improvement in my hearing, it is minimal.”
Reasons for Non-UsePoor Benefit
• “I don’t wear the aids at all. The problems appears to be clarity of words. Volume is OK but I can’t distinguish words”
• “I have not been able to wear the H.A. since the day I received it. It was made wrong and the Company said there was nothing wrong with it.”
Reasons for Non-UsePoor Benefit
• “It is not worth the trouble or expense for the small difference in hearing. I wish I had my money back.”
• “_____ aims at taking old people’s money for little value.”
• “All the aids do is amplify the sound that I can’t discriminate with an aid in the ear.”
Reasons for Non-UsePoor Benefit
• “When ______sold me the H.A., I was confident it would help me hear better. When I received it and wore it every day, it did not make my hearing any better. So, I don’t wear the HA and feel like I wasted my money. I tried to return it and the person did not seem to want to help me. I am quite dissatisfied with the whole experience.”
Reasons for Non-UsePoor Benefit
• “I can’t hear high pitch sounds with the behind the ear model.”
• “H.A.s amplify everything but human voices which is what you need to hear.”
• “____plugs are not worth the price.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
Reasons for Non-UseBackground Noise
• “I will not wear my H.A. because it increases background noise. And therefore, after a while I get a headache and get somewhat nervous.”
• “It catches all the sound on the road, TV, etc at the same time.”
• “Background noise is distracting.”
Reasons for Non-UseBackground Noise
• “H.A.s don’t work when there is a lot of background noise. This is when you need them to work.”
• “Background noise really drives him crazy.”
• “My problem is with background noise. All my H.A.s do is amplify so they are of little help.”
Reasons for Non-UseBackground Noise
• “I don’t wear my H.A. because I need it at a dance, restaurants, and large groups. All the H.A. does is increase all sound including background sounds. No help.”
• “Sudden loud noise is a killer.”
• “H.A. amplify other sounds so much that I actually feel pain.”
Reasons for Non-UseBackground Noise
• “If someone drops a spoon on the table it is like a rifle going off.”
• “Hate them. They don’t work for me. All sounds are amplified. Never knew there were so many. I can’t adjust the H.A. constantly to every noise.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
• #3. Fit & Comfort (19%) - 169,431
Reasons for Non-UseFit & Comfort
• “My hearing aids are too big for my ears.”
• “It is uncomfortable and my wife says I don’t listen to her anyway.”
• “It hurts my ears.”
• “I do not like the feel of it in my ear.”
Reasons for Non-UseFit & Comfort
• “I don’t wear my H.A. because they plug up my ears and feel uncomfortable.”
• “My H.A. has the tendency to fall out when I am working hard in hot weather.”
• “It’s hard to keep it in my ear. I travel for business a lot and can’t risk it falling out of my ear.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507• #2. Background noise (25%) - 229,383• #3. Fit & Comfort (19%) - 169,431
• #4. Negative side effects (11%) - 99,048
• Ears that hurt
• Too much pressure in the ears
• Blisters in ears
• Rashes in ears
• Itching ears
• Dizzy
• Nervous
Reasons for Non-UseNegative Side-effects
• Ears that sweat
• Builds up wax in inner ear
• Headache
• Hair gets caught in hearing aid
• Infections in ear
• Problems chewing or swallowing
• Plugs up ears
Reasons for Non-UseNegative Side-effects
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
• #3. Fit & Comfort (19%) - 169,431
• #4. Negative side effects (11%) - 99,048• #5. Price & cost (10%) - 93,839
Reasons for Non-UsePrice & Cost
• “I bought the H.A. when I was teaching. I had trouble hearing student’s questions. Since retiring I have stopped using them. They were costing too much for what good I was able to get from them.”
• “Programmable H.A. would be desirable but they cost too much.”
Reasons for Non-UsePrice & Cost
• “My current H.A. are broken & I am unable to afford the cost of a replacement. They are too old for service.”
• The expense of owning and maintaining are too great.
• HMO does not cover for HA. Price is high.
Reasons for Non-UsePrice & Cost
• “I enjoyed my H.A., but they burned up in a house fire and I can’t afford another one.”
• “I wish an aid would be developed to allow us to hear natural sound and an aid with a reasonable price.”
• “If I could afford it, I would buy a different brand.”
Reasons for Non-UsePrice & Cost
• “My H.A. was never dependable. Taking it in for an adjustment was only a headache as it never performed very long. Had to be looked at again. The last time I had trouble, the office wanted to send it to _____ at $200 & just to check it, plus another $200 to repair it.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
• #3. Fit & Comfort (19%) - 169,431
• #4. Negative side effects (11%) - 99,048
• #5. Price & cost (10%) - 93,839
• #6. Don’t need help (8%) - 72,987
• “I work and live alone and do not need the aid most of the time.”
• “I had an operation on my right ear and I can hear better again.”
• “I don’t talk to anyone during the day.”
Reasons for Non-UseDon’t Need Help
Reasons for Non-UseDon’t Need Help
• “I can hear most everything without H.A.s”
• I feel I was sold under false pretense. I don’t feel I really needed one.”
• “Don’t wear very often since my hearing loss is only 35 degrees.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
• #3. Fit & Comfort (19%) - 169,431
• #4. Negative side effects (11%) - 99,048
• #5. Price & cost (10%) - 93,839
• #6. Don’t need help (8%) - 72,987• #7. Broke or does not work (8%) - 68,814
Reasons for Non-Use Broke or does not Work
• “After a year, the H.A. is down. I can’t afford to repair them.”
• “Because it doesn’t work. ______ refused to do anything. The man that sold it to me has been fired.”
• “It does not work right.”
Reasons for Non-Use Broke or does not Work
• “I don’t wear it because after the warranty expired it got broken. It would cost $1,200 to replace it, so I quit wearing it.”
• “The housing is currently broken and will have to be glued back together. This is the fourth time it has broken.”
Reasons for Non-Use Broke or does not Work
• “It seems as if the aids were in the shop for repair more than in my ear. They are still not adjusted correctly for my comfort level. The cost of the repairs were too much. It is easier to go without them and have everyone speak louder.”
• “I have 2 H.A.s that don’t work. It costs $200 a piece cash to have them fixed.”
Reasons for Non-Use
• #8. Sound quality (6%) - 57,329
Reasons for Non-UseSound Quality
• “Never got true sound clarity I wanted”• Uncomfortable sound• Sound of crickets• Unnatural• Distorted• Slight hiss• Tinny• Picks up wind
Reasons for Non-UseSound Quality
• Chewing and swallowing noise
• Poor fidelity
• “Can’t stand sound of my voice”
• Hollow sound
• Aversiveness of sounds (running water, sharp sounds)
Reasons for Non-Use
• #8. Sound quality (6%) - 57,329
• #9. Won’t wear - unspecified (6%) - 57,556
• #10. Volume control adjust. (5%) - 44,314
• “I have trouble adjusting the sound.”
• “Hard to adjust. Every time the phone rings I have to adjust the volume.”
• “They need adjusting, because the background noises are annoying.”
Reasons for Non-UseVolume Control Adjustments
Reasons for Non-UseVolume Control Adjustments
• “They are a bother having to turn up & down too often.”
• “The volume never stays at setting.”
• “I can’t adjust H.A. constantly to every noise.”
Reasons for Non-Use
• #8. Sound quality (6%) - 57,329• #9. Won’t wear - unspecified (6%) - 57,556• #10. Volume control adjust. (5%) - 44,314
• #11. Whistling & feedback (4%) - 39,100
• #12. Nuisance / hassle (4%) -38,371
• #13. Poor service (3%) - 28,673
• #14. High frequency Loss (3%) - 26,067
Reasons for Non-Use
• #15. Stigma of wearing (3%) - 26,037
• #16. Profound hearing loss (3%) - 23,460
• #17. Work in limited situations (3%)-23,460
• #18. Uncomfortably loud (2%) - 27,114
• #19. Battery life (2%) - 19,186
Reasons for Non-Use1% or less of mentions
• Does not work on phone
• Monaural aids inadequate
• Expectations not met• Has Tinnitus• Manual dexterity• Forget to use
• Family pressure• Feels like ear plugs• Poor directivity• Low gain• Lost hearing aids• Ear wax problem• Rare social user
Key Findings• 907k inactive hearing aid owners• Key reasons:
– Poor benefit– Background noise– Fit and comfort– Cost– Negative side effects– Hearing aids broke
MarkeTrak V - Conclusions• Significant opportunities for improvement.
• Encouraging positive trends.
• Huge opportunity still waiting to be tapped.
• Need to find new marketing methods to reach “Baby Boomers”.