Effect of Hearing Aid Insurance Coverage Requirements for Adults on Utilization

成人助听器保险范围要求对使用的影响 摘要 在美国，听力损失影响着2/3%的12岁及以上的人。 70人有严重的听力损失。对于大多数听力障碍患者来说， 损失是使用助听器（即，戴在耳朵里或耳朵后面的小的可移动的电子装置， 放大声音），这可以改善沟通和生活质量。助听器一般不包括在内 约86%的听力损失病例未经治疗。但是，医疗补助提供助听器， 28个州和8个州的福利要求至少为一些成年人提供私人保险福利。这些覆盖 通过降低成本这一障碍，要求可能会提高助听器的使用率。我们的长期目标是 研究议程是了解改善听力对健康的影响。具体来说，我们的目标是 当前的应用是使用准实验（例如，差异中的差异）评估方法来估计 医疗补助和私人保险计划中的覆盖要求对助听器使用的影响。我们将使用 高质量、可重复的Anthem私人保险索赔数据、国家健康访谈调查（NHIS）数据， Medicaid claims-linked NHIS数据和Medicare Current Beneficiary Survey（MCBS）数据研究：（i） 助听器的国家私人保险范围要求对受益人购买助听器的影响 （二）医疗补助计划和私人医疗保险计划的影响 在NHIS中使用助听器的保险范围要求，以及 与医疗补助挂钩的NHIS和MCBS（用于双杀）;以及（iii）私人和医疗补助的影响 按人口群体划分的要求。我们的项目是重要的，重点是高比率的未经治疗的听力 损失;通过估计国家实施私人和公共保险覆盖要求的影响 关于美国成年人中助听器的采用情况（这为正在进行的国家 提供证据证明助听器的覆盖范围要求是否得到了很好的改善- 男性、种族/少数民族和受教育程度较低的个人在助听器使用方面存在记录在案的差异。 我们的项目是创新的，因为我们是第一个使用准实验差异的方法（ 可以提供因果证据），包括新的方法， 异质性治疗效果;利用目前未充分使用的强大数据源来研究听力 卫生保健获得和利用;通过原始政策构建详细的覆盖需求数据 我们将公开的研究。研究团队包括临床听力学、健康 经济学、高级统计建模、保险索赔数据和健康政策。拟议项目将 具有积极影响，因为解决负担得起和可获得的听力保健的系统障碍 有可能减少不平等和增加使用。

Effect of Hearing Aid Insurance Coverage Requirements for Adults on Utilization Abstract Hearing loss affects 23% of those aged 12 and older in the U.S. More than 2/3 of U.S. adults over the age of 70 have significant hearing loss. The most efficacious management option for most individuals with hearing loss is the use of hearing aids (i.e., a small removable electronic device that is worn in or behind the ear to amplify sound), which can improve communication and quality of life. Hearing aids are generally not covered by insurance and about 86% of hearing loss cases go untreated. However, Medicaid provides hearing aid benefits in 28 states and 8 states require private insurance benefits for at least some adults. These coverage requirements may improve hearing aid uptake by reducing costs as a barrier. The long-term goal of our research agenda is to understand the effects of improving hearing on health. Specifically, the objective of our current application is to use quasi-experimental (e.g., difference-in-differences) evaluation methods to estimate the effect of coverage requirements in Medicaid and private insurance plans on hearing aid use. We will use high quality, reproducible Anthem private insurance claims data, National Health Interview Survey (NHIS) data, Medicaid claims-linked NHIS data, and Medicare Current Beneficiary Survey (MCBS) data to study: (i) the effect of state private insurance coverage requirements for hearing aids on beneficiary hearing aid purchasing and out-of-pocket payments in fully-insured health insurance plans; (ii) the effect of Medicaid and private insurance coverage requirements on use of hearing aids in the NHIS, and Medicaid coverage requirements in the Medicaid-linked NHIS and MCBS (for dual-eligibles); and (iii) the effect of private and Medicaid requirements by demographic group. Our project is significant by focusing on high rates of untreated hearing loss; by estimating the effects of state implementation of private and public insurance coverage requirements on hearing aid adoption among U.S. adults (which provides evidence for the effects of pending national legislation); and by providing evidence on whether hearing aid coverage requirements improve well- documented disparities in hearing aid use for males, racial/ethnic minorities, and lower-educated individuals. Our project is innovative by being the first to use quasi-experimental difference-in-differences methods (which can provide causal evidence) for hearing health care research, including newer methods accounting for heterogeneous treatment effects; leveraging powerful sources of currently under-used data to study hearing health care access and utilization; constructing detailed coverage requirement data through original policy research that we will make available publicly. The research team includes experts in clinical audiology, health economics, advanced statistical modeling, insurance claims data, and health policy. The proposed project will have a positive impact because addressing system barriers to affordable and accessible hearing health care has the potential to reduce disparities and increase use.