The global hearing aid market is booming and this growth is expected to continue in the coming years due to demographic changes, resulting in a higher proportion of people over the age of 60. Not surprisingly, the prevalence of presbycusis remains.
In comparison to Europe, Switzerland has the lowest rate of hearing loss (7.7% of its population) and one of the highest rates of hearing aid use (44% of people affected). It is also the country in which the hearing aid population wears the device the longest each day (9.8 hours).
In an international comparison, the prices of hearing aids in Switzerland are the highest, behind the United States. How can this be explained and what official measures have been put in place to counteract this trend?
The Swiss hearing aid market
In Switzerland, 5 manufacturers hold 90% of sales and 3 companies together hold 80% of the market share. This is a situation comparable to that of the global market.
In 2018, between 80,000 and 85,000 hearing aids were sold in Switzerland, including :
- Hearing aids sold at Swiss acousticians ;
- Hearing aids purchased by individuals abroad;
- Direct imports by hearing aid specialists.
90% of hearing aid sales are BTE or mini BTE hearing aids.
More than 30 different brands and 2,700 models of hearing aids are approved on the Swiss market. Hearing aids are sold at hearing aid specialists, pharmacies and drugstores.
Price formation of hearing aids
The formation of the price of a hearing aid is part of a value chain that includes: producers, sometimes intermediary structures (wholesalers), hearing aid practitioners. At each stage, a margin is made on the price of the product. Thus, the price paid by an end user includes
- The price of the hearing aid (factory price),
- The margin realized during distribution,
- The price of the services provided by a hearing care professional.
Cost of components
In France, the French Competition Authority estimated that the price of hearing aid components, all ranges included, was between 70 and 140€ in 2016 (between 80 and 160CHF). The investigation revealed that the main components (digital microprocessors, microphones, earpieces) are mass-produced and thata large number of hearing aids are, therefore and from a technical point of view, almost identical . Their production cost is also similar for all ranges. At the end of the production line, a differentiation of the hearing aids according to the price range is carried out thanks to a software which restricts the access to certain functions. Thus, despite a similar production cost, the selling price of a hearing aid can vary greatly depending on the number of features activated.
Factory prices for hearing aids are higher in Switzerland.
The most popular hearing aids in Switzerland (mini BTE, RIE and RIC) are more expensive than the others. Their median price is 715CHF, which is 50% more expensive than a standard BTE hearing aid. In general, the most expensive instruments are almost twice as expensive as standard BTE hearing instruments and ITE instruments.
Wide variation in prices from country to country
In an international comparison, the study highlights a wide variation in prices from country to country for the same hearing instruments. Several factors influence the factory price:
Purchasing policy (importance of the private and public sector)
Switzerland is a strictly private market, with no state-run buying groups.
The study compares 30 models of hearing aids in different countries and underlines that the factory prices in the private market are, compared to Swiss prices, :
- 81% in France,
- 76% in Germany,
- 69% in Denmark,
- 66% in the UK.
Only in the USA are hearing aids more expensive than in Switzerland
A public purchasing policy can drastically reduce the cost of hearing aids: centralized procurement (Denmark, UK) is less expensive than individual sales to specialist shops, as is the case in Switzerland.
The different national reimbursement schemes
At the European level, there is a tendency to approximate reimbursement rates for end-users. The reimbursement rates include the hearing aid, accessories, examination, fitting of the hearing aid and follow-up by a hearing care professional over an average period of 5 to 6 years.
According to manufacturers, some of whom have decided to stop marketing their entry-level models in Switzerland, Swiss customers are demanding and expect a high level of quality. They seem to be willing to contribute significantly to the cost of a hearing aid and the demand for high-end devices is higher than in other countries. However, this explanation was qualified in 2009 by the former president of the Hearing Systems Manufacturers (HSM), Martin Hofer, who stated that “consumers are no longer simply persuaded to buy a more expensive product (…) but are much more likely to opt for a device that is fully reimbursed by social insurance
Lack of transparency of hearing aid manufacturers
The factory price is only part of the price charged by the hearing care professional to the end user. Hearing care professionals are free to set the selling price of hearing aids and to add the range of additional services (hearing test, adjustment of the device, replacement of parts, extended warranty, repair, etc.)
The prices charged by hearing care professionals are often not transparent. Even if the official guidelines and the standard form require that the part of the price related to the hearing aid and the part related to the associated services be indicated, the global invoicing often does not allow to identify the part of the final price attributed to the hearing aid. Simple comfort or deliberate tactic ?
In Switzerland, the selling price of a hearing aid varies between 430CHF and 5100CHF. A survey by “Kassensturz” points out that :
- The price for a similar hearing aid varies enormously from one point of sale to another, with a difference of up to 57%;
- Only the services related to the purchase of the hearing aid vary significantly, from 350CHF to more than 2000CHF, depending on the supplier.
According to specialists, there is no established link between the severity of the hearing loss and the extent of the fitting work and the cost of a hearing aid. For this reason, the Swiss Federal Social Insurance Office (FSIO) has abandoned a multi-level reimbursement system in favor of a single lump sum system.
Official recommendations to counter the practice of high prices
The official recommendations show a real ambition to fight against the practice of high prices specific to Switzerland in the hearing aid market.
As of July1, 2011, a new flat rate reimbursement system has been introduced. This flat rate aims to strengthen the decision making power of the insured and increase competition between professionals in the sector. Despite a slight decrease in prices, they have remained at a high level, due to the structure of the market and the country’s purchasing policy.
In the 6th revision of the first part of the Disability Insurance, it is now foreseen the possibility to launch a public tender for the acquisition of auxiliary means such as hearing aids. This new instrument aims to create real competition between suppliers. In addition, the Price Supervisor also recommends the following measures :
- Centralized procurement of hearing aids by a federal authority, directly from the manufacturers, through a tender process ;
- The delivery of hearing aids to users in major regional centers to optimize the efficiency of distribution ;
- Stricter control of the disability insurance (DI) regarding the application of the rules concerning the separate invoicing of hearing aids and associated services (for real transparency) ;
- Incentives for policyholders to compete among hearing care providers for additional services.
 “Hearing aids, Swiss market analysis and international price comparison” – Price Monitoring, Bern, January 2020. Author: Malgorzata Wasmer.
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