Recent budgetary evolution

Table 27 applies to devices reimbursed under Article 31 and delivered in 2006. The global budget for health care related to non-implanted hearing aids represented around

€20 million in 2006 which corresponds to 0.1% of the overall budget for health care reimbursement that year. Two billing codes, respectively referring to bilateral hearing aid fittings in adults and unilateral hearing aid fittings in adults made up 95% of that amount.

Table 27: Expenses for hearing aid reimbursements (2006).

NOMENCLATURE BILLING CODE EXPENSES #CASES EXP/CASE

679173 Bilateral hearing aid fittings for Patients aged 18 and older 14.566.628 € 72% 15.726 926 €

679136 Unilateral hearing aid fittings for Patients aged 18 and

older 4.719.154 € 23% 10.084 468 €

679195 Bilateral hearing aid fittings for Patients younger than 18 312.497 € 2% 198 1.578 € OTHER (11 Distinct Billing Codes) 671.761 € 3%

SUM 20.270.040 € 100% NA

Source: RIZIV/INAMI billing codes

Figure 24 depicts the evolution of the number of reimbursed unilateral and bilateral hearing aid fittings in adult Belgian residents by year of delivery for the period 1995-2005. Accounting for 2 HA per bilateral fitting a total of around 40 000 HA were delivered in 2005 through public reimbursement in the adult population of Belgian residents. An overall increase can be observed, mainly due to a marked rise in the use of bilateral hearing aid fittings.

Figure 24: Budgetary evolution (1995-2005) for two main billing codes.

0 5.000 10.000 15.000 20.000 25.000 30.000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 YEAR

NUMBER OF REIMBURSED DEVICES

# MONO DEVICES (NC 679136)

# STEREO DEVICES (NC 679173) COMBINED #

Source: RIZIV/INAMI billing codes

7.3.1.2 Demographic characteristics

Figure 25 gives an overview of all reimbursed expenses (article 31) for 2006 broken down by year of birth and gender. Patients between the ages of 60 and 90, incur 80% of all expenses. Women account for 53% of all expenses as indicated by the darker shaded part of the histogram, even while women have a lower age-specific prevalence of hearing loss than men (see chapter 1). Part of the explanation for this is obviously related to a better survival. Reimbursement of hearing aids in women is indeed more concentrated at older ages than in men. However, this is only a partial explication for the relatively large proportion of women who receive reimbursement for hearing aids, as will be shown in the explorations of demographic trends (7.3.2).

Figure 25: 2006 Expenditures by age and gender (genders stacked).

0 € 100.000 € 200.000 € 300.000 € 400.000 € 500.000 € 600.000 € 700.000 € 800.000 € 900.000 €

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

MaleFemale

Source: RIZIV/INAMI billing codes

As shown in Figure 26, bilateral hearing aid fittings made up 61% of fittings in 2006. Both for unilateral and bilateral hearing aid fittings women account for around 53% of all devices.

Figure 26: Number of unilateral (“mono”) and bilateral (“stereo”) fittings in adults (2006), by age and gender (genders stacked).

Source: RIZIV/INAMI billing codes

86 Hearing Aids KCE Reports 91

7.3.1.3 Geographic utilisation patterns

Geographic patterns in reimbursed hearing aids are analyzed on the following pages.

Figure 27 to Figure 30 concern consumption data directly standardized by age (groups of 5 years from the age of 20 onwards) and gender.

The ratio value “100” refers to the average observed value in the global Belgian population whereas the ratio values per region indicate the overall consumption if the regional consumption profiles by age and gender categories would be extrapolated to the Belgian population.

Respectively the figures show:

• Figure 27 and Figure 28: the number of bilateral hearing aid fittings in the adult population (billing code 679173)

• Figure 29 and Figure 30: the number of unilateral hearing aid fittings in the adult population (billing code 679136).

Table 28 gives an overview of the most important observations emerging from these geographic analyses. The overall variance in consumption patterns seems to be less pronounced for unilateral hearing aid fittings (coefficient of variation = 9%) as opposed to bilateral hearing aid fittings (coefficient of variation = 13%).

Table 28: Overview Information from geographic analyses.

VARIABLE VALUE FOR

RATIO = 100 MEDIAN MINIMUM MAXIMUM MEAN STANDARD DEVIATION FIG Reimbursed

Bilateral hearing

aid fittings 15.639 fittings Antwerp (107) Flemish

Brabant (86) Limburg

(125) 103 13 4-5

Reimbursed Unilateral hearing

aid fittings 10.045 fittings East Flanders (97) Limburg (88) Flemish Brabant

(115) 98 9 6-7

Also plotted on the charts (Figure 28 and Figure 30) are the numbers of shops per 100 000 capita per province as derived from Table 29, which does not allow for any clear-cut observations. This could be explained by the fact that these data do not take the actual size of various shops into account. Neither do they list shops that are not affiliated to one of the three major distribution chains.

Table 29: Number of retail points per Belgian province.

Distribution Chain

Province Veranneman Lapperre Dialogue Total

East Flanders 38 39 25 102

Source: 2007 data obtained from retail chains

As can be derived from the mapped data the most striking conclusion is that there seems to be an East West divide as regard the relative use of device types whereby the occurrence of unilateral and bilateral hearing aid fittings is more pronounced in respectively the Western and Eastern part of Belgium. Given the higher average reimbursement per bilateral hearing aid fitting (€926) compared to unilateral hearing aid fittings (€468), it should be expected that overall public reimbursement expenses for hearing aids show the same east-west divide.

Figure 27: Ratios by province, number of reimbursed bilateral hearing aid fittings (2006).

Source: RIZIV/INAMI Statistics (budgetary data) and Ministry of Economics (population data) Figure 28: Ratios by province (number of reimbursed bilateral hearing aid fittings 2006) and number of shops per 100 000 capita.

Source: RIZIV/INAMI billing codes (budgetary data) and Ministry of Economics (population data) and data collected by project researchers (shops per province)

88 Hearing Aids KCE Reports 91 Figure 29: Ratios by province, number of reimbursed unilateral hearing aid fittings (2006).

Source: RIZIV/INAMI Statistics (budgetary data) and Ministry of Economics (population data) Figure 30: Ratios by province (number of reimbursed unilateral hearing aid fittings 2006) and number of shops per 100 000 capita.

Source: RIZIV/INAMI billing codes (budgetary data) and Ministry of Economics (population data) and data collected by project researchers (shops per province)