The Subsidy Paradox: Why Older Adults Forgo Hearing Aids Despite Extensive Public Subsidy

Background/Purpose: Hearing aid uptake among older adults remains low despite the established benefits of hearing rehabilitation. In Israel, public healthcare subsidies significantly reduce out-of-pocket costs, creating a unique setting to examining barriers to hearing aid adoption beyond financial constraints. This study aims to identify barriers and facilitators that influence older adults` purchase of hearing aids in Israel and to examine the interplay among key factors.

Methods: This cross-sectional observational study includes older adults (aged 65+) with bilateral sensorineural hearing loss who were referred for hearing aid fitting. Participants were classified as purchasers or non-purchasers following referral. Data were collected via structured telephone interviews, including demographic questions, the Hearing Handicap Inventory for the Elderly Screening (HHIE-S), a study-specific barriers questionnaire, and open-ended questions.

Results: Preliminary analyses of 101 participants, including 63 purchasers and 38 non-purchasers, showed no significant group differences in age or hearing-related handicap scores; purchasers` HHIE-S responses reflected their aided condition. Audiometric hearing loss was significantly greater among purchasers. Purchasers reported significantly higher perceived necessity of the device, higher rates of sufficient audiological counseling, and greater family/social support. Non-purchasers reported significantly lower cost/subsidy awareness and greater competing health concerns. Qualitative data further highlighted visibility-related stigma and bureaucratic complexity as additional barriers.

Conclusion: These findings suggest that hearing aid uptake is shaped not only by self-perceived handicap or financial accessibility, but also by perceived necessity, social support, and healthcare navigation. Interventions should extend beyond subsidies to include targeted counseling, family involvement, and assistance navigating healthcare barriers.