title: [Hearing aid fitting: Effect of doubling the standard rate on compliance, quality of results, and excess payments].
abstract: BACKGROUND
  This study investigates the effect that doubling the standard rate for hearing aid fitting which is covered by statutory insurance has had on the size of excess payments and compliance, as well as on benefits for patients and their satisfaction.
  
  
  METHODS
  In April 2014, 859 members of a statutory insurance scheme (hkk) who received hearing aids in the 6 months prior to the reform were questioned on the timing and financial details of their hearing aid fitting, as well as on treatment compliance and quality of the results using a standardized questionnaire. In October 2014, the same questionnaire was used to collect these data from a further 622 insurance holders who had received hearing aids in the 8 months following introduction of the new regulation. Most of the questions concerning hearing quality corresponded to those of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.
  
  
  RESULTS
  The project revealed a statistically significant decrease of 6 percent points in the proportion of hearing aid users who had to pay any excess whatsoever; from 80.6% to 74.1%. However, 40% of the insured persons continued to pay an excess of 1000 euros and more. The subjective hearing quality remained practically unimproved by the reform and was statistically, almost without exception, independent of whether hearing aid users wore expensive devices associated with a large excess, or devices available at the standard rate. Finally, the study confirmed a previously recognized usage pattern characterized by noncompliance. For example, approximately 40% of hearing aid users did not wear their device in the everyday environment. This observation was independent of the size of the excess and the timing of the most recent visit to the hearing aid acoustician.
  
  
  CONCLUSIONS
  Despite doubling of the standard rate, three quarters of patients pay an excess--sometimes a substantial one. The subjective hearing quality was not improved by doubling the standard rate; the majority of patients continue to complain of considerable problems with hearing in difficult situations (environments with background or reverberant noise). Satisfaction with hearing quality is neither dependent on the doubling of the standard rate, nor on whether or not an excess was paid. Compliance may possibly be improved by structured follow-up, which should involve the prescribing otorhinolaryngologists, as well as phoniatrists, pedaudiologists, and hearing aid acousticians.
authors.affiliation: Zentrum für Sozialpolitik (ZeS), Universität Bremen, Bremen, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Braun
authors.affiliation: hhk Krankenkasse, Bremen, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Dietrich
authors.affiliation: Wissenschaftliches Institut für angewandte HNO-Heilkunde (WIAHNO), Deutscher Berufsverband der HNO-Ärzte e. V., Maienbeeck 1, 24576, Bad Bramstedt, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Akcicek
authors.affiliation: Klinik für HNO-Heilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Sektion für Phoniatrie und Pädaudiologie, Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Schönweiler
authors.affiliation: Wissenschaftliches Institut für angewandte HNO-Heilkunde (WIAHNO), Deutscher Berufsverband der HNO-Ärzte e. V., Maienbeeck 1, 24576, Bad Bramstedt, Deutschland. loehler@hno-aerzte.de.|Klinik für HNO-Heilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland. loehler@hno-aerzte.de.
authors.forename: J
authors.initials: J
authors.lastname: Löhler
mesh_terms: D000368:Aged; D017281:Cost of Illness; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006310:Hearing Aids / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D034381:Hearing Loss / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D017755:Prosthesis Fitting / Q000191:economics / Q000592:standards
keywords: Cost of illness; Health care costs APHAB; Hearing aids; Hearing loss