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DOI: 10.1055/s-0042-1758380
MarkeTrak—Tracking the Pulse of the Hearing Aid Market
Abstract
The MarkeTrak surveys conducted by the Hearing Industries Association have been looking at trends in the hearing industry since 1989. The latest survey, MarkeTrak 2022, reviews ongoing trends in hearing device adoption including PSAPs and implants, satisfaction with hearing aids and hearing professionals, and a look into insurance coverage and price considerations. These are discussed as they relate to the five key areas of the marketing mix: people, products, price, place, and perception. The key takeaways from this survey include: adoption has doubled in the past 25 years; more than 75% of hearing aid owners feel the hearing professional play an important role in their success with hearing aids; financial assistance has doubled since 1991 to 54%; and additional efforts are needed to educate consumers on the technology and benefits of hearing aids and early intervention.
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Keywords
hearing aid adoption - hearing aid channels of distribution - self-report hearing loss - insurance coverage - hearing aid satisfactionWhat has changed in the hearing industry since the initial wave of MarkeTrak back in 1989? The short answer is, “a lot.”
As you will see through this article, the hearing device market is complex and continues to evolve. This article will explore how the market, and our understanding of the market, has changed across five key elements of the marketing mix based on insight gained from the collective MarkeTrak studies (see [Table 1]). All data gathered are self-reported. “Perception is reality” in the eyes of the consumer.
|
People |
Product |
Price |
Place |
Perception[a] |
|---|---|---|---|---|
|
Segments, diversity, varied needs, etc. |
Devices, adoption, satisfaction, etc. |
Costs, coverage, value, etc. |
Channels, professionals, etc. |
Awareness, impressions, intentions, etc. |
a The fifth “P” is listed here as “Perception,” not the typical “Promotion” since this study takes an industry view.
Research Method Overview
The initial waves of this study (from 1989 to 2008) were conducted with a mail survey using the National Family Opinion Panel. When the mail panel was dissolved, the 2015 survey was conducted online using Dynata sample sources. The most recent survey (MT2022) was conducted in November and December 2021. As shown in [Fig. 1], this wave was conducted with 15,138 households and collected information on 43,957 individuals in those households. From that sample, 3,218 individuals with self-reported hearing loss, including 1,139 hearing aid (HA) owners, provided additional information on their experiences (Note: More details on the method are included at the end of this article.)
People—The Target Market
While the market has changed in many ways, the hearing difficulty rate has remained relatively stable. As shown in [Fig. 2], the percentage of individuals in the United States with self-reported hearing difficulty has been around one in ten since the initial wave of the MarkeTrak study back in 1989. Other constants include the incidence of hearing difficulty increasing with age and the largest market segment being seniors. Despite these consistent backdrops, MarkeTrak has expanded our understanding of the range of individuals who have this condition.
About four in ten (43%) individuals with self-reported hearing difficulty assume this condition is a normal part of aging. As shown on the far left of the chart in [Fig. 3], the proportion listing this cause increases with age. Many also attribute their hearing loss to noise exposure. The proportions listing noise exposure on the job, from recreation, or from loud music peak among those 25 to 44 years of age. This is a different target market. There was a slight increase in the level of self-reported loss among individuals in this age range in 2022, and this may be the start of a trend.
In MT2022 we took a closer look at how hearing difficulty varies by several demographic variables, including race/ethnicity. As shown in [Fig. 4], Black, indigenous, and people of color (BIPOC), and Black individuals specifically, have lower self-reported rates of hearing difficulty when compared with White individuals. Similar findings have been reported in other studies. There are still questions about whether there is a real difference in the prevalence of the condition or if this is driven by a difference in self-reporting.
It is important to remember that individuals with hearing difficulty are not one homogenous group with consistent needs and wants. When repeat buyers of hearing aids were asked what increased in importance when purchasing their latest hearing aids, the most common factor noted (and the only factor for six in ten or more) was sound quality (64%). Once individuals try hearing aids, they focus on what matters most when they upgrade—hearing well. When looking across age groups, however, there are some interesting differences. For example, over six in ten of those younger than 35 years also placed more emphasis on the size of the hearing aid (68%), its appearance (61%), and wireless capabilities (60%). Over six in ten of those 35 to 64 years of age placed more emphasis on physical comfort (61%). There were no factors listed by six in ten or more of those aged 65+ except sound quality; they also were the least likely to place more importance on size (25%) and appearance (21%).
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Products—Hearing Aids, Implants, and PSAPs
As shown in [Fig. 5], the adoption rate for hearing aids has increased substantially over the course of MarkeTrak, from 22.9% in 1989 to 38.4% in 2022. The 2022 rate includes hearing aids purchased through all channels. The MT2022 survey asked about more hearing devices in total and in detail: hearing aids from multiple channels (those fitted in person, those fitted remotely, and self-fitting), hearing implants, and personal sound amplifiers (PSAPs). When implants are included, the 2022 adoption rate is 39.1%; when implants and PSAPs are included, the adoption rate is 42.5%. While some still assume that hearing aid adoption rates are in the low 20s, we believe our extensive survey provides a more accurate reflection of current adoption rates.
There is also a difference in adoption rates across demographic segments. Older individuals (age 65 + ), and individuals with higher incomes ($100K + ), have the highest adoption rates for hearing aids fitted in person. MT2022 showed that the PSAPs and other purchasing channels have more relative appeal in other segments (discussed more later).
Hearing aid technology has improved consistently over time. Perhaps the most significant change in the past 25 years was the shift from analog to digital hearing aids, which were developed in the 1980s and started to have a market presence in the late 1990s. This shift allowed for digital manipulation of the sound wave instead of merely increasing the size of the sound wave. The digital signal processing capabilities provide better sound quality and less feedback. Today's hearing aids are often wireless, allowing individuals to control settings using a smartphone. Other advancements include noise reduction, feedback suppression, directional microphones, artificial intelligence, streaming, and rechargeability.
As the technology has improved, satisfaction with hearing aids also has increased. As shown in [Fig. 6], more than eight in ten of all hearing aid owners are satisfied with their hearing aids compared with rates closer to six in ten in the earliest waves of the MarkeTrak study. Owners with hearing aids purchased in the last few years have even higher satisfaction levels (with closer to nine in ten being satisfied), as newer hearing aids are more likely to have improved and/or have higher-end technology.
As shown in [Fig. 7], satisfaction rates vary by hearing device. The percentage of owners who are satisfied with their hearing device is highest for hearing implants, followed by hearing aids, and then PSAPs. This may be explained in part by a difference in the user or usage for each device. For example, implant owners are younger than hearing aid owners and rely more heavily on their implant for day-to-day functioning. PSAP owners, similar in age to hearing aid owners, are more often situational users—using their device when watching TV and communicating at home.
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Place—Channels of Distribution
Hearing care is changing in many ways, including changes in delivery and purchasing models. In addition to more devices, the MT2022 study asked about different hearing aid channels focusing on how hearing aids were fitted. At this stage in the development of alternative channels, and prior to over-the-counter (OTC) legislation going into effect at the time of the survey, the traditional channel, which is hearing aids fitted in person by a hearing care professional, is still the most common. As shown in [Fig. 8], over eight in ten current hearing aid owners classify their hearing aid that way. About one in ten (12%) has hearing aids that were fitted remotely, and an even smaller percentage (7%) has self-fitting devices or those classified as “direct-to-consumer.” In the MT2022 survey, the goal was to get a stake in the ground for these channels to prepare for a more complex market going forward. We are continually analyzing data and assessing the best way to describe and differentiate devices, fitting methods, and channels to minimize consumer confusion in future waves.
As shown in [Fig. 9], rates for hearing aids fitted in person are highest within the 65+ segment, followed by the youngest segment (<35 years of age), and the adoption curve is U-shaped. When looking at the shape of the curve for other channels and devices, the rate is highest within the youngest segment and decreases with age. These other hearing aid channels and other devices also have higher adoption rates among BIPOC individuals than among White individuals. Relatively speaking, these channels are more successfully targeting, or are simply more appealing to, different audiences.
Despite more options to purchase hearing aids, professionals still play a key role in the adoption process. Half (52%) of the individuals with hearing difficulty have discussed their hearing issue with a medical doctor. Among those who have, almost half (45%) were referred to a hearing care professional, and four in ten (39%) received a recommendation to get their hearing tested by a professional.
Hearing care professionals are still influential and valued. When hearing aid owners are asked to specify what influenced them to get hearing aids, the number 1 reason is a hearing test that demonstrates a need (59%), followed by working with a hearing care professional they trust (49%). As shown in [Fig. 10], among those with hearing aids that were fitted in person, almost nine in ten feel the hearing care professional played an important role (helping them moderately or a great deal). Most individuals who got a device on their own (a self-fitting hearing aid or PSAP period.) feel they would likely have benefited from working with a hearing care professional along the way (36% moderately and 35% a great deal).
As shown in [Fig. 11], most, but not all, individuals who have intentions to get hearing aids in the near future would lean toward working with a hearing care professional in person (which we refer to as the “traditional channel”). Those leaning toward a virtual experience (and a remote fitting) are younger on average than those who prefer the traditional channel. They are more comfortable with technology and virtual services. Those up for more of a “do-it-yourself” process and leaning toward a self-fitting hearing aid may be trying to save money, as they have lower-than-average incomes than those who prefer the traditional channel. These are questions we will likely explore in future waves. What we know now is that consumers are exploring alternative options in greater numbers, and alternative channels are adding slices to the adoption rates.
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Price—Costs and Coverage
As shown earlier, the majority of current hearing aid owners are satisfied with their product. They are also quite satisfied with the value their hearing aids provide for the money. As shown in [Fig. 12], most hearing aid owners who got their device in the past 5 years are satisfied with the overall value (85%) and the out-of-pocket price paid (74%).
The percentage of hearing aid owners who report having some type of financial assistance has been on the rise since 1991. As shown in [Fig. 13], the rate has almost doubled over the course of this tracking study. The most typical sources listed among hearing aid owners in MT2022 were Medicare (19%), insurance (16%), and the military/VA assistance (13%). The majority of those receiving assistance (74%) were aware of their level of coverage upfront.
Cost and lack of/limited insurance coverage are barriers to purchase for some hearing aid non-owners, however. As shown in [Fig. 14], a substantial proportion of the non-owners in the MT2022 survey who got a recommendation to get a hearing aid from a hearing care professional indicated that hearing aids are too expensive (55%), they cannot afford these (40%), or they lack coverage (31%). Other top reasons include feeling their loss is not severe enough (at 23%) or wanting to gather information first (22%).
MarkeTrak surveys and other studies have shown that individuals with hearing loss need to be ready (acknowledge the need), willing (ready to accept them), and able (have adequate resources) before they will pursue a solution. The importance of being ready and willing (not just able) can be demonstrated by an experiment embedded in the MT2022 study. This showed changes in purchase intent across a range of scenarios that varied in price and coverage. One random subsample of non-owners was asked their likelihood to purchase hearing aids in the next 2 years if the entire cost were covered by insurance. As shown in [Fig. 15], if hearing aids were free, only about half (51%) of these non-owners feel they would probably or definitely get hearing aids, and about one in five (19%) think they probably or definitely would not.
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Perceptions—Images and Motivations
When it comes to perceptions of hearing aids, hearing aid owners and non-owners have different images in mind. Owners attribute many positive changes in their life to hearing aids. Many non-owners are not aware of, or not convinced that, the technology has improved, or they do not feel the benefits would outweigh the financial, physical, and emotional costs.
What do hearing aid owners think about hearing aids? Almost two-thirds of owners (65%) feel they should have gotten their hearing aids sooner and attribute positive changes in their life to their hearing aids. As shown in [Fig. 16], most hearing aid owners who got their device in the past 5 years say it improves their quality of life, and for the majority it does so regularly. This proportion has increased fairly dramatically since 2015 when this question was added to the survey.
As shown in [Fig. 17], over half of hearing aid owners feel their ability to communicate, their work lives, and the personal lives are better off in many ways due to wearing hearing aids. Almost as many (at 45% or more) credit hearing aids for increasing their self-confidence, relationships at home, and sense of independence.
Now on to hearing aid non-owners. Non-owners who received a recommendation to get a hearing aid and did not follow through, along with those who have never had their hearing professionally tested, have a variety of reasons for stalling out. [Fig. 18] shows the proportion of people who are hesitant to get hearing aids or get a professional test (a critical step in the process of adoption) because of negative associations they have with hearing aids. As shown, almost one-fifth say they would be embarrassed to wear a hearing aid in public (19% of those avoiding a hearing test and 17% of those not ready to get hearing aids). Almost one-quarter of those who have not yet had a hearing test are not ready to fully admit they have a hearing loss (24%), along with 16% of those who are not ready to purchase a hearing aid even though a professional recommended it.
Even though some non-owners feel their hearing loss is not severe enough to warrant hearing aids, most recognize they are missing out. As shown in [Fig. 19], only about one-third (36%) of non-owners are satisfied with how well they hear overall. Even fewer are satisfied with the quality of their hearing when having a conversation in large groups (27%), and when there is background noise (25%). Hearing aid and implant owners are two to three times more likely to be satisfied in these settings.
In addition to a limited willingness among non-owners to admit they have a need, there is also often a lack of knowledge about the advancements in hearing aid technology and how new technology can improve the user experience. For example, only 18% are aware there is a smart phone app that allows hearing aid users to control hearing aid settings through a cell phone. As shown in [Fig. 20], almost one-third do not think any technological improvement or feature would motivate them to purchase sooner, and the most intriguing features offer basic functionality dealing with control volume levels and rechargeability.
While these features are clearly important in contributing to ease of use, non-owners are more likely to say they would be motivated by better insurance coverage (44%) or a test that substantiates a need (31%), as shown in [Fig. 21].
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Summary
Our goal for this introductory article is to highlight important findings, trends, and considerations for the future. Key takeaways include:
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People: Consumers are not a homogenous group with consistent needs and wants.
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Products: Adoption rates have nearly doubled in the past 25 years, and technology advancements have led to increased satisfaction rates.
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Place: Over three-quarters of hearing aid owners feel that the hearing care professional played an important role; most of those who self-fit or own PSAPs feel they would have likely benefitted from assistance.
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Price: Financial assistance has doubled since 1991, increasing from 22 to 54%. While the majority of hearing aid non-owners feel the cost is too expensive, hearing aid owners are satisfied with the value for the price paid.
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Perception: Hearing aid owners tout the benefits of hearing aids, but consumers, in general, need to be educated about the advancements in hearing aid technology and the benefits of addressing their hearing loss.
Other articles that follow in this journal will provide more detail on specific topics.
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Research Method
Fielding for the online waves occurred over time, and upfront sample management techniques were used to control the distribution of respondents across key variables to minimize the need for back-end weighting. This was performed by managing sample sources and setting quotas using the most recent U.S. Census estimates (2018 estimates for the 2022 wave) for each region within the country on age, household income, gender, marital status, household size, race/ethnicity, and education (in total and within each region). The final dataset was then weighted to align with U.S. Census data on region, age, gender, and income. Weighting was done at the household head level to further align data with adult household heads within the United States. Weighting was secondarily performed at the individual level (for all household members including children), to align with census estimates for all individuals within the United States. Comparisons across subgroups were assessed using an independent sample t-test. All tests were two-sided and p-values less than 0.05 were considered statistically significant.
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Conflict of Interest
None declared.
Address for correspondence
Publication History
Article published online:
01 December 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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