Semester Project

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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 kindof hearingaidthat appealsto
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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