Thinking about hearing aid adoption in Japan

After the publication of Japan Trak 2012 (Japanese part of Euro Trak 2012), Ako Hidekazu, President of JHIMA (Japan Hearing Instruments Manufacturers Association) published an article in the journal of the Japanese Society for Wellbeing Science and Assistive Technology. Audiology Worldnews* presents a summary of his article.

Differences in hearing aids adoption due to differences in systems between Europe, the USA and Japan

It seems that the differences in hearing aids adoption between several countries are mainly due to the healthcare and welfare systems of each country. In Western countries, hearing impaired people who want to adopt hearing aids have a clinical examination by an ENT before adopting hearing aids, and when an ENT recognizes the necessity for hearing aids adoption, a hearing aids technician with a national or an official qualification is responsible for fitting the device. In these countries, as most hearing aids are delivered by public institutions, or the fee is covered by health insurance, the patients pay nothing or their contribution is low. In contrast, in Japan, there is no framework that obliges people who want to have hearing aids to go to ENTs for diagnosis, if they are not recognized as hearing impaired by the authorities. The decision on eligibility for financial support from the authorities lies with ENTs. If patients have profound or severe hearing loss with hearing at more than 70 dB in both ears, they can be considered eligible. Most patients with mild or moderate hearing loss pay for hearing aids and fitting themselves. For people with these levels of impairment, the financial burden is larger than in Western countries. Another problem in hearing aids adoption in Japan is that there is no hearing aids technician qualification officially recognized by the authorities. Therefore, every employee in hearing aids stores can do fitting work. This major difference between the systems in Japan and Western countries is the reason behind Japan’s hearing aids adoption rates (Fig.1)

Hearing aids adoption rate and QOL (Quality of Life) improvement

The hearing aids adoption rate in Japan is the lowest in comparison with the other countries. This suggests that people with hearing impairment in Japan do not improve their QOL (Quality of Life). As ENTs often point out, hearing impaired people gradually withdraw from society. As they cannot communicate like before, their family and friends become increasingly distant from them. Finally, they may even become isolated and have a solitary existence. If hearing aids adoption improves, there will be fewer isolated people with hearing impairment and quality of life could be improved. We know from Japan Trak that the number of hearing impaired people is 10.9% of the total population, i.e.around14 million and the hearing aids adoption rate is 14.1%, i.e. around 2 million people are fitted. 1% of the hearing aids adoption rate corresponds to 140,000 people. When we look at the number of hearing aids sold in Japan, as published by JHIMA for the ten year period from 2003 to 2013, we see an increase of only 70,000 devices. As there are binaural hearing aids users, the real number of increased users is less than 70,000. It is very difficult to increase hearing aids adoption by 1%.

Important factors to increase the hearing aids adoption rate

To improve this rate in Japan, it is important to solve the problem of a different system in Eastern countries. For this purpose, we could aim to change legislation on the healthcare and welfare systems. But this is a very difficult task. Rather, in order to improve the hearing aids adoption rate, it would be more effective and faster to accelerate the training of hearing aids technicians certified by the Association for Technical Aids, a public interest incorporated foundation. This is what the hearing aids industry in Japan has continued to do since 1989.

Since the Association for Technical Aids was founded in 1987, the Oto-Rhino-Laryngological Society of Japan and other organizations in the industry such as the Japan Hearing Instruments Distributors Association, the Japan Hearing Instruments Technicians Association, and the Japan Hearing Instruments Manufacturers Association have joined forces to reach more than 2,600 certifid hearing instrument technicians. In January 2014, this number reached 3,000. The hearing aids industry recommends having more than one certified hearing instrument technician in a store, but in many stores there is no technician at all. More recognition of the need for hearing instrument technicians is necessary.

The Oto-Rhino-Laryngological Society of Japan announced the creation of the hearing aids consultant doctors system in 2005. Today, they are around 4,000. They are tasked with caring for patients in collaboration with certified hearing instrument technicians. For patients who need to have hearing aids, they establish medical need and refer patients to stores where a certified hearing instrument technician is available. Certified hearing instrument technicians to whom patients are referred prepare a “fitting report” and the result of the fitting is forwarded to the ENT who has referred the patient.

If the cooperation between hearing aids consultant doctors and certified hearing instrument technicians can be boosted, the number of hearing impaired people isolated from society could be reduced and these patients could enjoy higher quality of life once they recover their hearing.

The main factors influencing the hearing aids adoption rate are the healthcare and welfare systems, but the role of digital hearing aids is also important. Fifteen years after the incorporation of digital hearing aids in JHIMA’s statistics in 1998, this type of device occupied 80% of the market. With improved quality, function, and design the market share increased, negative images of hearing aids decreased, and user satisfaction improved. There is no doubt about the contribution of digital devices to improvement in the hearing aids adoption rate.

In conclusion, the best way to improve the hearing aids adoption rate in Japan is to urgently create a situation in which cooperation between hearing aids consultant doctors and certified hearing instrument technicians is fostered throughout Japan. Thus, in my opinion, we need more understanding and cooperation from persons involved in the hearing aids industry.

I believe that in the future, this cooperation between both parties will become a motivation to change healthcare and welfare systems in Japan to improve hearing aids adoption.

*This article was published for the first time in issue 24 of Audio Infos Japan.

Ako Hidekazu, President of JHIMA (Japan Hearing Instruments Manufacturers Association)

Photo: A.H.