How to widen the Brazilian hearing aid market?

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The Secretary General of the European Hearing Industry Manufacturers Association (EHIMA), Søren Hougaard, visited Brazil in May in order to seal a partnership with the ABIMED, the domestic association for health devices and equipments importers. The main goal of the cooperation is to take advantage of the EHIMA’s know-how in terms of research. The Brazilian companies have the will do develop a study similar to EuroTrak. Under EHIMA’s responsibility, EuroTrak provides a wide range of data about European hearing care markets and the user’s habits and satisfaction.

For hearing aids makers, the potential market may look like a mirage… they can catch a sight of water in the distance, but as they come closer, they’re just left with the sand! Indeed, there are hundred of millions of hearing-impaired people across the world and, at the same time, a still narrow hearing aid market. Total sales are about 10 million of instruments per year, and among them less than one million is dispensed in developing countries while the World Health Organization estimates the annual needs for these nations overcome 30 million devices. Whatever are the reasons, the industry has been unable to meet the needs.

5% of hearing-impaired persons using hearing aids in Brazil

When it comes to fitting the hearing-impaired population, Denmark – where are based three of the world biggest hearing aid manufacturers – ranks first. Yet, even in this country, the percentage only reaches 45%, according to a statistic by Goldman Sachs Research. With an estimate of 5% of hearing-impaired persons using hearing aids, the situation in Brazil is clearly worse. How to best address this issue was the reason of Søren Hougaard visit to Brazil in May. The Secretary General of the European Hearing Industry Manufacturers Association (EHIMA) held a meeting in São Paulo at the ABIMED, the Brazilian Association for High Technology Health Equipments and Products.

The EHIMA brings together the six largest HA makers: William Demant Group (with the brand Oticon and Bernafon), Sonova Group (Phonak and Unitron), GN ReSound, Widex, Siemens and also Starkey, a US-based company which is a big actor of the European market. Søren Hougaard explained that although it’s a European organization, the EHIMA is looking at the world as a whole, including an American HA manufacturer as well as working closely with organizations in other countries. “That’s why I’ve come to Brazil and why we’re doing market research in Japan with the Japan Hearing Instruments Dispensers Association”, said EHIMA’s Secretary. The organization has been also maintaining a partnership with the US Hearing Industry Association (HIA) for several years allowing sharing all kind of information related to the field.

“There is a general lack of knowledge”

The goal of Mr Hougaard’s visit in Brazil was to establish a partnership with the ABIMED and make available EHIMA’s knowledge and know-how. The EHIMA, which was founded in 1985, publishes every year the EuroTrak, a study that provides a wide set of data about the hearing care field in several European countries. The information includes, among others, the (self-reported) hearing loss prevalence, the age of HA owners and the total adoption rate, a long-existing concern.

“Globally, we’re reaching less than 20% of the hearing-impaired people, it is ridiculously low and we want the number up”, Søren Hougaard said, “there are several parameters to think about to do that, among them: education, awareness campaigns and initiatives to raise the professional level so that people are being fitted by skilled staff.” The hearing aid industry has been frequently criticized for the prices of its devices but according to Mr Hougaard, this is not the key factor to explain the low percentages of fitted hearing people across the world. “There is a general lack of knowledge, people don’t know what a hearing aid could bring them, and even in Denmark and England, they are not aware that they can get hearing aids for free”, he stated.

HA = hardware + services

However, it is worth recalling that the three countries that fit more than 30% of its hearing-impaired population – Denmark, UK and Australia – have all large public support available along with a private segment, thus showing prices considerations are far from neutral. Actually, the 2009 EuroTrak survey for France – where the users have to cover the major part of the hearing aids cost – showed that the impossibility to afford hearing aids was the main reason not to get the devices. The price of a hearing aid is not just about the product itself. It also reflects the services provided along with the device, including diagnosis, fitting tests, follow-up and rehabilitation. In terms of costs, Brazil suffers nowadays from some drawbacks as prices and salaries have strongly risen over the recent past years. As a mixture of hardware and services, HA prices tend to go up when services become more expensive.

The psychology of hearing loss

In the industry’s opinion, commercializing cheaper devices is not a solution. “To get satisfied users, you need a professional fitting, on the contrary you get bad feedback from customers and then enter a vicious circle”, states Søren Hougaard, “so cheap products and lousy services are bad for our field, and we insist on the quality of the whole process, from the first meeting to the very last goodbye.” According to Phonak Brasil CEO and Abimed director Pedro Stern, who attended the meeting with EHIMA’s secretary, the biggest issue is related to the lack of information and the challenges faced to provide the public with it. “hearing-impaired people need in average seven years to search for treatment when they become aware of their problem, so it takes years to decide”, he recalled. Consequently short term campaigns don’t produce effect while larger and longer term campaigns only can be run by associations or governments.

A EuroTrak-like study for Brazil

The professionals’ ability to adequately communicate with hearing-impaired people is another key point for the industry. “It’s one thing to know about neurological processes but if you are not aware of the psychology of hearing loss, then you don’t know how to talk to these persons”, said Mr Hougaard, “the day they go to the hearing aid dispenser is probably not the happiest day of their life, so it’s necessary to understand their mood.”

In the wake of the partnership between EHIMA and ABIMED, an independent market study should be launched in Brazil in the second 2012 semester. There’s no accurate independent data about the Brazilian hearing aid market. The only available statistics is the number of devices annually imported. It is issued by the Ministry of Development and barely provides an idea of the market size (more or less 300,000 unities, including 200,000 bought by the government). Once the market study concluded, the next step will be to initiate a EuroTrak-like study for Brazil. EuroTrak is based on 15,000 persons in each country. The sample is categorized according to many criteria to ensure it is representative in terms of income, age, geography, etc. “The main problem is to map the social impact and cost of hearing impairment, we can benefit from the research already done in European countries, especially those with similar market structure, that is divided between public and private segments”, said Pedro Stern. Using the EuroTrak methodology will allow saving time and money. Moreover, based on similar methods, Brazilian and European results will easily sustain comparison. Finally they will provide information to define strategies to implement together with hearing care professionals as well as the authorities, the ultimate goal being to improve the covering population with hearing aids.

Stéphane Davoine