Benefit-Cost Analyses of Hearing Aids, Over-the-Counter Hearing Devices, and Hearing Care Services.

PURPOSE: Limited accessibility to hearing health care threatens healthy aging in place for older adults with hearing loss. A willingness-to-pay (WTP) approach was used to determine benefits and value of prescription advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing devices, and rehabilitative services using benefit-cost analyses. METHOD: This study was a cross-sectional survey with chart review of hearing aid users at two independent audiology practices. Seventy hearing aid users (response rate: 15.6%) provided their WTP for ADT prescription hearing aids, OTC hearing devices, and hearing rehabilitative services. Benefit-cost ratios and net social benefit were calculated using deterministic and exploratory approaches. Point estimates for benefit-cost ratios and net social benefit were derived using bootstrap sampling with replacement (N = 5,000). RESULTS: Median WTP for ADT prescription hearing aids and rehabilitative services were $2,000 and $250, respectively. WTP was lowest for OTC devices (Mdn = $0; maximum = $500). Benefit-cost ratios and net social benefit for ADT prescription hearing aids, OTC devices, and hearing rehabilitative services favored these interventions when out-of-pocket costs remained low. Benefit-cost analyses also produced results favoring prescription ADT hearing aid intervention with costs as high as $1,530 per device. CONCLUSIONS: WTP results indicated that all interventions under study have a measurable consumer-perceived benefit. Results of benefit-cost analyses favored the interventions but only when costs were lower than market prices. The benefit-cost analysis results for hearing care services underscore their value when provided as part of a comprehensive rehabilitative plan that may inform future health policy changes.

Subjective evidence evaluation survey for many-analysts studies.

Many-analysts studies explore how well an empirical claim withstands plausible alternative analyses of the same dataset by multiple, independent analysis teams. Conclusions from these studies typically rely on a single outcome metric (e.g. effect size) provided by each analysis team. Although informative about the range of plausible effects in a dataset, a single effect size from each team does not provide a complete, nuanced understanding of how analysis choices are related to the outcome. We used the Delphi consensus technique with input from 37 experts to develop an 18-item subjective evidence evaluation survey (SEES) to evaluate how each analysis team views the methodological appropriateness of the research design and the strength of evidence for the hypothesis. We illustrate the usefulness of the SEES in providing richer evidence assessment with pilot data from a previous many-analysts study.

Hearing aid affordability in the United States.

PURPOSE: Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to estimate the proportion of Americans with functional hearing loss for which out-of-pocket expenditures for hearing aids would be unaffordable at current average costs and determine how affordability varies by sociodemographic factors. MATERIALS AND METHODS: We utilized data from the 2016 American Community Survey to determine the proportion of adults with functional hearing loss for whom hearing aids would constitute ≥3% of annual income or have post-purchase income below a poverty standard. Chi-square tests were used to identify differences in affordability outcomes by sociodemographic characteristics. RESULTS: Results indicated that an average bundled cost of $2500 would constitute a catastrophic expense for 77% of Americans with functional hearing loss (N = 7,872,292) and would add an additional 4% of the population into poverty for the year (N = 423,548). Affordability outcomes varied significantly by age, race, sex, educational attainment and geographic location. CONCLUSIONS: Hearing aids were unaffordable for three-fourths of Americans with functional hearing loss, and their purchase would result in impoverishment for hundreds of thousands of individuals. Reductions in out-of-pocket hearing aid costs to $500 or $1000 would alleviate affordability issues for many Americans with hearing loss. Future federal and state policy should address poor rates of insurance coverage for hearing care, specifically among Medicare and Medicaid, to reduce out-of-pocket costs for hearing care particularly for older adults.Implications for rehabilitationAn average out-of-pocket hearing care cost of $2500 was unaffordable for over three quarters of Americans with functional hearing loss.Hearing care affordability varied significantly by demographic characteristics such as age, sex, gender, educational attainment and geographic region.Affordability constitutes a significant barrier to hearing care accessibility in the United States, where most costs of hearing aids and rehabilitation are statutorily excluded from insurance coverage, including the largest insurer of Americans, Medicare.

Semester Course Load and Student Performance.

Many college students in the United States take longer than four years to complete their bachelor's degrees. Long time-to-degree can increase higher education costs by billions. Time-to-degree can be reduced if students take more credits each term. While academic momentum theory suggests that additional credits may also improve student performance, and there is a strong positive correlation between course load and student performance, high course load may reduce time investment in each course, giving high course load a negative causal effect on performance. Concern about the negative impact of course load on performance, especially for struggling students, may lead to pushback against policies to reduce time-to-degree by increasing course load. Using longitudinal data from a regional four-year university with a high average time-to-degree, we find no evidence that high course loads have a negative impact on student grades, even for students at the low end of the performance distribution. This result is consistent with a model where students substitute time away from non-education activities when their course loads increase.

The Long Road to Equality: A Meta-Regression Analysis of Changes in the Black Test Score Gap over Time.

OBJECTIVE: We analyze changes in test score gaps between Black students and their peers from 1979 to 2010 and examine how observable factors contribute to the gap. METHODS: Using meta-regression, we examine the relationship between African American racial status and achievement in United States K-12 education in 165 published studies. RESULTS: The absolute relationship between Black status and achievement decreased during the 1980s and early 1990s, but was stagnant from the late 1990s through 2010. Socioeconomic status explained more than half of the gap, and the influence of socioeconomic status on the gap did not changed significantly over time. Schooling characteristics explained relatively little of the gap, but school-level factors increased in importance over time. CONCLUSIONS: Black test score gap closure stagnated in an era when federal education policy sought to close racial achievement gaps. Observable factors explain more of the gap than has been previously recognized.