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Stacey-Ann Ellis

Semester project

Critical Health Issues

12/07/14

Hearing loss and other preventive care in the health care system

Hearing loss is the deviation from normal hearing, above 25 decibels. If an individual’s

threshold, the lowest level of sound one could hear is above 25, then this individual is considered

to have some level of hearing loss. With a classification of either mild, moderate, severe or

profound, severe to profound individuals would be considered deaf. As society ages, more elders

suffer from hearing loss whether through aging (presbycusis), exposure over time due to their

profession, everyday activities or even through sickness like meningitis. Treatment of hearing

loss is inherently affected by the healthcare system; doctors cannot cure hearing loss, but they

can stagnate the progression. Before the Affordable Care Act (ACA), many older Americans at

the retirement age did not have an adequate coverage for preventive services, much less the

coverage of hearing aids. Medicare had few preventive care measures where there is a “Welcome

to Medicare” visit, but afterwards the beneficiaries no longer received preventive coverage.

Through the ACA, there are some measures that are considered better than its previous state.

Hearing loss is categorized and defined in three forms, depending on the part of the

auditory system that is damaged according to the American Speech-Language Hearing

Association. The first is conductive hearing loss, which occurs when sound is not conducted

efficiently through the outer ear to the ear drum and the ossicles of the middle ear. It usually

involves a reduction in sound level or the ability to hear faint sounds. (ASHA, Conductive

Hearing Loss, n.d.). Secondly, the sensorineural hearing loss, which occurs when there is

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damage to the cochlea, or to the nerve pathways from the inner ear to the brain. (ASHA,

Sensorineural Hearing Loss, n.d.). The third is a mixed hearing loss, in which both the inner and

outer ear or middle ear (cochlea or auditory nerve) is affected or damaged. (ASHA, Mixed

Hearing Loss, n.d.). If the loss of hearing is not approached as soon as possible, the level and

kind of hearing loss would be progressively worst. The progression could eventually cost more

than it would if it had been treated at an earlier stage. Though Medicare is an entitlement

program and is given at the age of 65, mostly, some people still do not go to the doctor because

they are afraid that they will get the bill that Medicare does not cover, hence, hearing aids.

Access

Access is the price, the quality, the information, the socioeconomic status and so much

more that affects the service with health sectors. Access to health care is to have means to how

one will acquire information whether through news broadcast, commercials, computer access,

brochures, doctor’s office at a hospital or clinic, through a neighbor, and ability to afford. Based

upon where one lives and their income, these kinds of access varies significantly. According to

the research on NIDCD Working Group on Accessible and Affordable Health Care (HHC) the

National Institute on Deafness and Other Communication Disorders conducted, it states that:

“Hearing health care” includes assessment and access to hearing aids and non-medical treatment. “Access” includes hearing screening/assessment as well as acquiring an appropriate device and services for the individual’s hearing loss and communication needs. HHC access can be confusing to the consumer, with ill-defined professional roles and competing financial interests among provider groups. Multiple entry points include family practitioners, audiologists, hearing aid specialists, otolaryngologists, and direct Web access, as well as magazine, newspaper, and television ads…

None of the categories can function on their own, meaning that having internet access and

brochures do not do any good if one does not have access to a provider that could help or if one

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does not have the money or any insurance coverage. In the United States compared to many

other countries, we are among one of the only nations that does not provide an all-around care

for its citizens. (NIDCD Workshop: Accessible and Affordable Hearing Health Care, 2009).

Citizens have to go out to the market and find a provider and if they do not have the means or an

exchange within their proximity, the blame is on the citizens. Insurance coverage plays a

significant role in accessibility. If there are locations that would provide care that is in a

travelable distance, which in itself is access, then the access of coverage and financial security in

terms of paying it off would be covered. Also, having a place to go to check on health where the

population is not in millions, like Loving County in Texas with a population of 95, recording to

be one of the least populated places in the United State. (Loving County, Texas, 2013) Having

some kind of access like a clinic would play an important role.

Cost

In the United States, between the ages of 65 and 75, one third of the population has some

degree of hearing loss, but 80% of those who could benefit from hearing aid(s), do not receive

them due to cost; 35 % of Americans have household income of less than $35,000, with an

unemployment rate of 9%; 76 % of them mentioned that their finances are barriers to their

adoption to the aid, while 64 percent admitted to not being able to afford the aid. (NIDCD

Workshop: Accessible and Affordable Hearing Health Care, 2009). If 70 % of individuals with

hearing aids requires 2 heating, then that is roughly $4,000-$6,000 out of their pocket for the

device; the fittings and other coverage like paying the Audiologist and maintenance may or may

not be included in the overall price.

Socioeconomic disparities in health care also exist in Hearing Health Care (HHC). The estimated number of Americans with underserved HHC could be higher than for health care in general because of the high cost of hearing aids and complex

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access to these devices. Acquiring appropriate HHC may be especially challenging for the “working poor.” It is important to remain conscious of the underserved, economically disadvantaged, and less advantaged.

Easily, half of that individual’s income could be spent paying for the 2 aids and follow-ups.

While the life span of a hearing aid depends on many factors, in general, hearing instruments

have an average life of four to six years. A hearing aid wearer, over the wearer’s lifetime, may

spend tens of thousands of dollars acquiring and maintaining hearing aids. From the age of 65 to

85, $20,000-$30,000 could be spent on hearing aids alone. Given these factors, hearing aids can

be among the most expensive items purchased by many Americans with hearing loss. Also, “the

high health care costs in the U.S. are partly due to the high incomes earned by the medical sector

[but] because the medical sector has no incentive to cut their own costs, that just costs their

income.” (Gruber, 2011, p. 100). No one wants to change their habits and no one wants their

income to reduce, resulting in the constant rise in costs. The poorer individuals find it difficult to

keep up with a dynamic system such as the U.S health care system, especially the poorer older

adults who have retired.

Quality

The quality of care is highly dependent upon

the outcome or the presentation of information by a

given health care provider, whether in person or

through other means of communication channel. On

the other hand, the quality of the hearing aid is

dependent upon the type of hearing aid one receives

which inherently affects the outcome, whether patient A new kind of hearing aid that appeals to fashion.

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satisfaction in terms of clarity or comfort. People are highly sensitive to how doctors approach

their ailments, therefore, plays an important role in patient satisfaction overall.

Ensuring quality is vital in all considerations and deliberations. “Research

recommendations were designed to lead to outcomes increasing accessibility and affordability of

hearing health care, ultimately leading to a decrease in the number of hearing-impaired adults in

the United States”. (Research Needs in Accessible and Affordable Hearing Health Care for

Adults With Mild to Moderate Hearing Loss, 2014). It may be beneficial to initiate hearing

health care, maintaining quality of life, before cognitive or other age-related health declines

occur. It would be beneficial if they are able to make decisions for themselves without someone

talking over them or for them at appointments because everyone likes their autonomy no matter

their age and hearing aids increases this possibility from one area of their lives.

Arguments

According to the Health Care website, on Preventive health services for adults, “most

health plans must cover a set of preventive services…” No two insurance policies have the same

plan where they outline what they cover and what they do not. Though this may have been the

case, before the Affordable Care Act, according to the Medicare Rights Center, “Beneficiaries

with Original Medicare were required to pay 20 percent of the cost of most preventive services

out of pocket. Medicare Advantage plans could charge what they wanted for preventive

services.” With this in place, it reduced the amount of people going in for checkups to capture

ailments in there early stages, but with the charges being applied and plans charging what they

want, it did not encourage people to go and get regular checkups. With the Affordable Care Act

in place, most of the preventative care services are provided free of charge. Medicare before the

ACA also “covered a one-time ‘Welcome to Medicare’ visit during the first 12 months of

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Medicare Enrollment”. This of course encouraged the elders to go and get their physical checkup

at their doctor free of charge with nothing to worry about within their time limit. (The Affordable

Care Act: Before and After, n.d.).

After the initial checkup Medicare would not pay anymore, leaving the balance to be

covered by the patient and not their insurance if they went and receive any preventive care

services. The ACA changed this provision where it now allows annual “wellness” visits. This is

something that the Medicare beneficiaries are entitled to and it is paid in full unlike having to

pay 20 % coinsurance previously for the visit, which could easily fluctuate the price from a low

amount to a high amount depending on the checkup they received and what the doctors felt like

charging, factoring in the fraudulent behaviors by doctors taking advantage of the Medicare

program. With this visit, patients may develop a preventive plan with their doctor and how to

follow through. With this initiation, it motivates elders to go and get their annual check up to

ensure that they maintain the best possible health. (The Affordable Care Act: Before and After,

n.d.).

It is important that one maintains a good health by catching their ailments as soon as one

possibly can. Elders do not have the bodily strength that is as resilient as that of a younger

person. Without treating illnesses, the older adult’s health can go into a rapid decline. In a

country where death is viewed as unnatural because we have so many technological advances

that helps to counter or improve one’s illness, whether young or old, there need to be much

attention paid on their behalf. An older adult’s life expectancy may not be the same as that of a

young child because they have already lived their life. Without elders, many traditions would not

be able to pass down to children, grandchildren and so forth. That connection and inclusion in

family affairs is affected by one’s ability to hear and share. Though Medicare is an entitled

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program because these individuals have contributed to society their whole lives or their spouse

have, without the proper benefits to ensure longevity and good health, the program does not

make a lot of difference in terms of preventive care.

When the ACA allows annual wellness visits for preventive care, it remedies the cost in

contrast to that of a fully blown illness will provide. In comparison to a checkup that may cause a

few thousand dollars to the cost of a cochlear implant (if the deafness persists too long without

the proper treatment), it would have benefited everyone if aid for hearing aid was provided.

According to the American Academy of Otolaryngology, “The evaluation, surgery, device, and

rehabilitation for cochlear implants can cost as much as $100,000”. (cochlear Implants, n.d.).

Most of the people on Medicare may not be able afford this service without help, because they

already could not afford approximately $6,000 for 2 hearing aids. Cochlear Implants are for

people who are no longer benefited from assistive devices like hearing aids, where these

individuals have sensorineural hearing loss. The health insurance coverage for hearing services

in this sense is important for it would counter the possibility of bankruptcy for the elders, putting

the burden on the offspring if there is any.

The ACA is rather different than Medicare, in the sense that it opens more access to

services needed to increase the quality of life one lives. An example of this is from the policies

referring to the ACA in New York State of a Benchmark Plan, the Oxford EPO, Small Group

Plan as it varies in all the states:

Hearing aids covered; however, bone anchored hearing aids are excluded except when either of the following applies: (a) persons with craniofacial anomalies whose abnormal or absent ear canals preclude the use of a wearable hearing aid, or (b) persons with hearing loss of sufficient severity that it not be remedied by a wearable hearing aid. Covered hearing aids, except for bone anchored hearing aids, are limited to a single purchase (including repair/replacement) every 3 years,

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with a maximum recoverable amount of $1500. Covered bone anchored hearing aids are limited to 1 per lifetime. 

Although this provision may not seem like a lot, it is better than nothing at all because many

elders are focused on their ability to take care of other ailments that they face each day and just

withdraw from having conversations because it may not be detrimental to them. Funds may be

allocated in other areas such as providing meals, paying for their housing, taking care of family

or paying a health care worker like a Home Health Aide if old enough and needs the required

services. On the U.S. Department of Health and Human Service website on Prevention and

Public Health Fund, there are 21 programs that receive funding for educating, enhancing and

supporting initiatives for treatment and preventions, but none of which includes hearing health

and hearing loss prevention educating program.

There should be more done to prevent hearing loss, among other preventive ailments,

through education. Advising on how damaging ear pieces can be, the effects of cerumen (wax)

impaction, cleaning ears, exposure to loud music in home or at a concert, blow dryers, alarms,

and work noise exposure like drilling or mowing a lawn. There are many factors in our everyday

life that sets the stage for hearing loss at an older age, and more so each day as technology

advances. The amount of people with hearing loss has doubled in the past 30 years, with a

projected 28.6 million, according to the American Speech-Language Hearing Association.

(ASHA, The Prevention and Incidence of Hearing Loss in Children, 2000). According to the

World Health Organization “there are 360 million persons in the world with disabling hearing

loss, [of which] 328 million are adults, which is higher than the United States’ current population

at 319 million. (WHO, 2014),

I may be able to understand why hearing health may not be covered in the insurance policies as

much. While the loss of hearing can make someone become depressed and withdrawn, develop

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distrust in others because they think someone is talking down on them, intentionally whispering

so that they cannot hear, and isolation among many others, it does not stop someone from living.

Life may become harder, but it is not directly life threatening. Another situation where I may be

able to understand why the insurance companies do not have provisions in their policies for

hearing loss is that it may become costly. The cost for diagnosis, treatment plan, device,

advancement of the device, maintenance afterwards to fine tune for the individual’s surrounding,

battery replacements and purchases, repairs and replacements of the hearing aid, all adds up after

a while; each patient differs from the other. Therefore, they may need more services like speech

reading, lip reading or both to better cue what the aid is picking up. But I don’t not believe that

this perspective qualifies as a reason not to include it. Hearing aids or hearing loss do not cost as

much as chemotherapy or dialysis, but it does affect one’s quality of life. Getting the device,

helps the patients feel like themselves again and feel as if they are a part of their family with the

ability to contribute in conversations, rather than completely withdrawing themselves. According

to our text for the semester, Our Unsystematic Health Care system, it stated that Medicare does

not pay for dental care, hearing aids and hearing exams, routine eye care and most eyeglasses, or

such necessities….” (Budrys, 2012, p. 91). It is a wonder that the Affordable Care Act came into

play and changed that, because while hearing loss may not directly lead to health problems, the

process of progressive hearing loss may lead to depression, consequently leading to death.

Therefore, there needs to be some prospects presented in not most, but all insurance policies.

Hearing health affects everyone, while it only takes a second of a loud noise exposure to affect

one’s hearing health permanently. By including this provision in the policy, we set a standard

and also add a safety net for our health status in the future as well.

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According to our text for the semester, Our Unsystematic Health Care system, it stated

that Medicare does not pay for dental care, hearing aids and hearing exams, routine eye care and

most eyeglasses, or such necessities….” (Budrys, 2012, p. 91). It is a wonder that the Affordable

Care Act came into play and changed that, because while hearing loss may not directly lead to

health problems, the process of progressive hearing loss may lead to depression, consequently

leading to death. Therefore, there needs to be something present in not most, but all insurance

policies; hearing health affects everyone, while it only takes a second of a loud noise exposure to

affect one’s hearing health permanently. By including this provision in the policy, we set a

standard and also add a safety net for our health status in the future as well.

As a culture, I believe that physicians and doctors need to review the Hippocratic Oath

that they recited at their graduation about their techne and how they would provide care that does

not violate the patients, not work out of greed, but to work in the best interest of the patient. The

Pledge or Oath was an honor and for doctors who violates the system, preventing others from

progressing highly, affects the outcome of preventive care. Doctors swore to protect the patients,

but in today’s society, we care more about the money that we can make off of someone rather

than how to treat patients in a way that yields positive outcomes. Why treat someone for

something when you can postpone their sickness with a drug that suppresses rather than cure

someone? Insurance companies needs to start working on preventive care as well because if

every baby boomer should have a full blown disease that could have been prevented with the

right medication, with inability to pay back and the lack of ability to work it off because they are

retired, these companies would go in bankruptcy, especially with the new law that prevents

insurance companies from dropping individuals with different kinds of ailments. The insurance

companies should promote preventive care, for their financial purposes in the near future. We

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need to do better to become better as a whole. “Some people argue that we should be putting

greater emphasis on prevention of health problems before they occur.” (Budrys, 2012, p. 150).

While some people are advocating for this initiative, I believe that everyone should want

providers to take preventive measures if there is one, because if you, the patient, is in a situation

where the doctor knew the preventive measures and did nothing for you except suppress the

symptoms of for example, Diabetes, with drugs until you have the disease fully, no one would be

happy with that outcome. I believe we should fight for society’s well-being, the way we would

fight for our own well-being.

We have seen articles such as “five ways why the American health care system is literally

the worst” (Kliff, 2014) and I have watched an entire hearing on improving the U.S. health care

system by learning from the other countries (Tsung-Mei Cheng, Ching-Chuan Yeh, Sally C.

Pipes, Danielle Martin, Jakob Kjellberg, David Hogberg, Victor G. Rodwin, 2014). The problem

is that the United States is the biggest country in terms of span which highly affects how

resources are allocated. The United States cannot use systems like universal health insurance or

national health insurance, because while in other countries people may appreciate government

involvement in their health affairs, it is not the same in America; people like choices and not

choices that are government run. America needs to come up with a system that works and one

that open the doors for preventive care to decrease the amount of people affected by diseases,

infections and viruses that could have been avoided, if a comprehensive system was to be in

place. There needs to be a change in the way we look at things and approach them, away from

our perspective on personal gains. Otherwise, we will continue to rank lower and lower, really

becoming the worst in the health care system throughout the world.

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BibliographyAffordable Care Act. (2013, August). Retrieved November 5, 2014, from Hearing Loss Assocoiation of

America: http://www.hearingloss.org/content/affordable-care-act

ASHA. (2000). The Prevention and Incidence of Hearing Loss in Children. Retrieved November 6, 2014, from American Speech-Language Hearing Association: http://www.asha.org/public/hearing/Prevalence-and-Incidence-of-Hearing-Loss-in-Children/

ASHA. (n.d.). Conductive Hearing Loss. Retrieved November 6, 2014, from American Speech-Language Hearing Association: http://www.asha.org/public/hearing/Conductive-Hearing-Loss/

ASHA. (n.d.). Mixed Hearing Loss. Retrieved November 6, 2014, from Americcan Speech-Language Hearing Association: http://www.asha.org/public/hearing/Mixed-Hearing-Loss/

ASHA. (n.d.). Sensorineural Hearing Loss. Retrieved November 6, 2014, from American Speech-Language Hearing Association: http://www.asha.org/public/hearing/Sensorineural-Hearing-Loss/

Budrys, G. (2012). Our Unsystematic Health Care System (Third ed.). Plymouth, United Kingdom: Rowman and Littlefield Publishers, Inc. Retrieved November 20, 2014

cochlear Implants. (n.d.). Retrieved November 20, 2014, from American Academy of Otolaryngology-Head and Neck Surgery: http://www.entnet.org/content/patient-health

Foster, W. (2014, February 26). Comprehensive Medicare Coverage of Audiology Services. (Youtube) Retrieved November 20, 2014, from American Speech-Language Hearing Association: http://www.asha.org/Advocacy/Comprehensive-Medicare-Coverage-of-Audiology-Services/

Gruber, D. J. (2011). Health Care Reform (First ed.). (H. Zimmerman, Ed.) New York: D&M Publishers, Inc.

Hendren, S. (2010, May 1). Adaptation, Part II: hearing aid jewelry, chairs that give hugs, and the art of changing the question. Retrieved November 20, 2014, from Alber: http://ablersite.org/2010/05/01/adaptation-part-ii-hearing-aid-jewelry-chairs-that-give-hugs-and-the-art-of-changing-the-question/

HHS. (2014, February 25). Prevention and Public Health Fund. Retrieved November 20, 2014, from U.S. Department of Health and Human Services: http://www.hhs.gov/open/recordsandreports/prevention/

Kliff, S. (2014, June 16). Five ways the American health care system is literally the worst. Retrieved August 27, 2014, from Vox: http://www.vox.com/2014/6/16/5812898/five-ways-the-american-health-care-system-is-literally-the-worst

Loving County, Texas. (2013). Retrieved December 7, 2014, from United States Census Bureau: http://quickfacts.census.gov/qfd/states/48/48301.html

NIDCD Workshop: Accessible and Affordable Hearing Health Care. (2009, August 25-27). Retrieved November 5, 2014, from The National Institute of Health: http://www.nidcd.nih.gov/funding/programs/09HHC/pages/summary.aspx

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NIHSeniorHealth: Hearing Loss. (2012, December). Retrieved November 5, 2014, from NIHSeniorHealth: http://nihseniorhealth.gov/hearingloss/hearinglossdefined/01.html

Preventive health services for adults. (n.d.). Retrieved November 20, 2014, from HealthCare: https://www.healthcare.gov/preventive-care-benefits/

Research Needs in Accessible and Affordable Hearing Health Care for Adults With Mild to Moderate Hearing Loss. (2014). Retrieved November 5, 2014, from American Speech-Language Hearing Association: http://www.asha.org/aud/Articles/Research-Needs-in-Accessible-and-Affordable-Hearing-Health-Care-for-Adults/

Staff, M. C. (2014). Hearing Aids: How to choose the right one. Retrieved November 5, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/in-depth/hearing-aids/art-20044116

Staff, M. C. (2014). Hearing Loss Causes. Retrieved November 5, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/causes/con-20027684

Staff, M. C. (2014). Hearing Loss Complications. Retrieved November 5, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/complications/con-20027684

Staff, M. C. (2014). Hearing Loss Prevention. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/prevention/con-20027684

Staff, M. C. (2014). Hearing Loss Risk Factors. Retrieved November 5, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/risk-factors/con-20027684

Staff, M. C. (2014). Hearing Loss Treatments and Drugs. Retrieved November 5, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/treatment/con-20027684

The Affordable Care Act: Before and After. (n.d.). Retrieved November 20, 2014, from Medicare Rights Center: http://www.medicarerights.org/pdf/2012-aca-fact-sheet.pdf

Tsung-Mei Cheng, Ching-Chuan Yeh, Sally C. Pipes, Danielle Martin, Jakob Kjellberg, David Hogberg, Victor G. Rodwin. (2014, March 11). Subcommittee on Primary Health and Aging. Subcommittee Hearing - Access and Cost: What the US Health Care System Can Learn from Other Countries. Dirksen. Retrieved November 20, 2014, from US Senate Commitee on Health, Education. Labor and Pensions: http://www.help.senate.gov/hearings/hearing/?id=8acab996-5056-a032-522e-e39ca45fcfbe

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