The hearing aid market - France

1.2 A growing global market

Hearing aid sales of EHIMA members World, ****-****, million units CAGR: *.* Source: ****

The graph shows the evolution of the number of hearing aids sold by the members of the European Hearing Instrument Manufacturers Association (***), the world's largest hearing aid manufacturers The global hearing aids market was growing steadily until ****, before the health crisis The number of prostheses sold between **** and **** increased by *.* million units, an average increase of *.*% each year. The health crisis unfortunately stopped this growth dead in its tracks as the number of prostheses sold fell by **% between **** and ****, a first after years of growth. The president Eric Bernard explains that the he hearing aid market relies heavily on customer contacts, which was difficult to achieve during the pandemic, but despite this, it is not worried because demand is still there and EHMIA is prepared to manage the impact of the pandemic on the industry .

Rate of equipment for the hearing impaired and hearing aid users Part of Europe, ****, % Source: ****

A major indicator for understanding the hearing aid market is the penetration rate, defined as the rate of hearing aid equipment among a target population. Among people with hearing loss, it was **.*% in France in ****. The rate of equipment ...

1.3 Presentation of the French market, an important market with strong growth prospects

Hearing aid sales of the top * hearing aid manufacturers France, **** - ****, in thousands of units Source: ****

The French hearing aid market has been experiencing sustained growth for several years. According to the SNITEM (***), but the French market has therefore weathered the health crisis better than the global market. The growth continues since in the first half of ****, the number of sales increased by **.*% compared to the last quarter of ****

  Hearing aid sales of the top * hearing aid manufacturers, by category France, ****-****, thousands of units Source: ****

The market is primarily driven by the growth of the remote earphone segment, which represents **% of sales in ****. BTE hearing aids represent **% of sales, a segment that saw a slight decline in sales between **** and **** (***). With *% of hearing aid sales, in-ear sales grew by a remarkable **% between **** and ****

Evolution of the size of the hearing aid market France, ****-****, billion euros CAGR: *.* Source: ****

The market was estimated from the sales volume given by Ouïe magazine (***) and the average price of a hearing aid given by AMELI which was estimated at ****€. The turnover found in **** according to our method corresponds to that found by the health insurance Ameli over the same year, confirming our ...

1.4 Impact covid

Hearing loss due to COVID-** infection?

Anosmia (***) are known symptoms of the virus, but some have wondered about hearing loss. In October ****, a patient was officially deafened by a Covid-** infection diagnosed as deaf [***]. If correlations between the two phenomena are proven, one can imagine that this would be a growth factor for the market with an increase in demand

The health crisis did not cause too many waves on the national market, as we saw in section *.*. The source of concern was the closure of hearing centers during the containment period, with *,*** centers affected in France, as well as the cancellation by telephone of all appointments for the coming weeks by the *,*** hearing aid practitioners in France.

In this context, Unsaf set up a "minimum service for continuity of care for patients requiring urgent care, in particular a breakdown in their equipment". This service allowed hearing aid batteries and maintenance products to be sent by post, advice to be given by telephone and, after a telephone call, an appointment to be made at one of the duty centres still open if the problem was urgent [***].

2.1 Demand based on medical needs

Inelastic demand

Hearing aids are in demand because they are necessary for life in society. Hearing loss is a handicap that needs to be overcome. Thus, a **** study by UNSAF in fact, it has been shown that the demand for hearing aids is inelastic to price. On the one hand, demand is increasing (***), and prices remain stable, as shown in the following graph:

Evolution of the average price of hearing aids France, **** - ****, in euros

Source: ****

We can see that between **** and ****, the average price of hearing aids oscillates around ****€.

Hearing aid equipment rate

A distinction is made between people with hearing loss, who suffer from more or less serious hearing damage, and people who can be fitted with hearing aids, who suffer from damage that can be treated by using a hearing aid. In France, the rate of equipment for the hearing impaired population is **.*%. The rate of equipment for the hearing-impaired population is **.*% for the same year. The rate of hearing aid equipment illustrates the level of demand of the French population according to hearing pathologies.

2.2 A demand linked to the ageing of the population

The ageing of the population and the increase in life expectancy

While life expectancy has only increased over the last ** years for both men and women (***), health is still a major concern for society.

According to the INSEE With a population of **.*** million as of January *, ****, France has approximately one in ten people over the age of **, and people aged ** and over represent **.*% of the population (***), which only confirms the ageing of the population, a population that has needs in terms of medical equipment to increase its comfort of life and the management of its dependence

Age-related hearing loss

The DREES estimates that in ****, ** million French people had hearing problems, i.e. about **% of the population at the time, and for more than half (***) it was a question of moderate to total loss, likely to have repercussions on their daily life. Nearly ***,*** people were affected by severe hearing loss.

Distribution of hearing impairment (***) by age group France, ****, in % Source: ****

From the age of ** onwards, more than **% of the population has at least mild hearing problems. The functional limitations of hearing, whether moderate or total, therefore mainly concern the elderly: **% of those affected are over ** years old, **% are ** years old or ...

2.3 Reasons for non-equipment: price

The rate of equipment in hearing aids is only **% in France in **** according to data from the association UFC Que Choisir With more than *.* million people not equipped.

For the consumer association UFC Que Choisir, this under-equipment is mainly due to the high price of hearing aids. As we have seen, the average price of a hearing aid in France was €*,*** for one ear and this has not changed much since ****, including post-purchase services (***). The purchase price is therefore higher, which increases the barriers to purchase.

In contrast, the " macron Act " of * August **** on growth, activity and equal economic opportunities has however posed the possibility of a solution. Indeed, its article ** removes from the Social Security Code (***) the necessarily indissociable character of the fitting, adaptation and follow-up. It is therefore possible to dissociate the stages, with first the payment of the prosthesis and then the payment of the follow-up appointments one by one, which will no longer have to be made at the place of purchase. However, there is still a major obstacle: the French health insurance system is not considering separating the device and follow-up services for the time being. In the meantime, hearing aid practitioners will not be able ...

2.4 Prosthesis renewal

Time to renew hearing aids by year France, ****, % Source: ****

In a study conducted by Health Insurance since **** and published in ****, it was found that **% of patients had returned to a hearing aid before **** when they had been fitted with two devices in the period ****-****. Most renewed both hearing aids (***) and about *% replaced only one from **** to ****.

According to the Health Insurance, the time before the first renewal is *.* years on average, but it is always heterogeneous, depending in particular on the use of the prostheses, the care given by their users, but also on the need to change the technical capacities of the prostheses. The renewal cycle varies between *.* and * years. Approximately **% of patients with a hearing aid have renewed their hearing aid between * and * years after the date of fitting.

This cycle is shorter for those under ** years of age, averaging only *.* years for those under ** years of age, and *.* years for those between ** and ** years of age, due in part to the increasing need to fit hearing aids, both medically (***)

3.1 Hearing aid manufacturers and hearing aid practitioners

A distinction must be made between, on the one hand hearing aid manufacturers whose activity is purely industrial and the activity of the audioprosthesists who adapt prostheses to the morphology of their patients' ears

Steps to take to get a hearing aid:

Source: ****

The first thing to do is to take stock of your hearing by going directly to an ENT. The free assessment is not essential, but can be useful to get a first idea

The assessment determines the type of deafness: conductive deafness (***) or mixed deafness. The ENT doctor then issues a prescription for a hearing aid to be fitted by a hearing aid specialist.

The audioprosthesist makes a *D impression of the ear and ear canal using a silicone paste and a syringe. Once this *D silicone model is obtained, it is scanned to have the model modelled on *D software in order to make alterations, if necessary, and to print it in *D.

The hearing care professional presents the various hearing aids that best meet the client's criteria, including the shape of the device. He or she provides follow-up to ensure that the device is properly fitted and that the client is satisfied

Production

Source: ****

Phonak shows ...

3.2 Distribution

There are not many distribution channels for hearing aids, the two main ones being hearing aid stores and pharmacies.

The purchase of hearing aids is regulated by law and it is impossible in France to buy hearing aids on the internet as the law obliges hearing aid specialists to receive the patient in a hearing centre. It is possible to find "hearing aids" on the internet, but these are hearing amplifiers that are not necessarily adapted to the patient and have a limited effectiveness, moreover, they are not eligible for social security coverage.

Breakdown of hearing aid sales by distribution channel France, ****, % Source: ****

The distribution of hearing aids and related services is carried out by approximately *,*** sales outlets throughout the country. Most of these are specialized hearing aid stores, which control **% of the market, although optical stores also offer a range of products and account for *% of the market by value, while some pharmacies also sell certain hearing aids.

Distribution of outlets and hearing aid expenditures by number of hearing aids sold France, ****, in % Source: ****

However, there are disparities within the sector, with high activity stores (***) that sell less than *** devices and generate only **% of the turnover.

Distribution of hearing aid ...

3.3 The players: dependence between distributors and brands

Competition is strong among hearing aid manufacturers. There are * international players in the production industry GN Hearing , Sanova (***), Prodition , Followers , Starkey and Widex . [***]

As of ****, Widex and Sivantos have merged to create WS Audiology . This merger of two major hearing aid players has created a strong company with combined sales of more than EUR *.* billion, more than **,*** employees worldwide and one of the largest R&D teams in the world

The second aspect of the market consists of the prosthetists who resell the prostheses to consumers. The latest available data, dating from ****, show Audika and Amplifon as leaders in the distribution of hearing aids with **% and *% market share respectively.

Market shares of the various hearing aid distribution chains France, ****, % Source: ****

This shows that, overall, the manufacturing and distribution market is relatively concentrated in the hands of a few players, or their associated franchises.

Vertical integration in the hearing aid market :

Source: ****

There is a dependency between hearing aid dispensers and manufacturers. The manufacturer can take a total or partial stake in the distributor's capital, and can also play the role of a bank with advantageous business financing conditions. For the manufacturer, this allows him to control the distribution network and to ...

4.1 A wide range of hearing aids

As said earlier, the hearing aid market is generally divided into three product categories, namely:

In-the-ear prostheses ; BTE prostheses that contour the user's ear; The remote headphones.

In addition to the hearing aids In addition, there are sound amplifiers on the market that are sometimes called " listening assistants "These are pre-set devices with a maximum power of ** decibels. These devices, not adapted to real hearing pathologies but rather intended for occasional help, are over-the-counter and are not reimbursed by health insurance.

A hearing aid consists of three elements: a microphone, the body of the hearing aid which adapts the sound to the type of deafness of the individual, and finally a loudspeaker which reproduces the sound. In addition to these elements, there is a battery that powers the device.

The choice of hearing aids by patients depends on the medical diagnosis, consisting of an audiogram and an interview with a doctor, but also on the personal criteria of the patient. In the end, here is a list of the main determining criteria:

The intensity of hearing loss: technical performance of the instrument ; The form-factor: general design, discretion of the device, compatibility with glasses; The patient's abilities: dexterity, mobility, memory... ; The patient's ...

4.2 All price ranges of hearing aids

As a reminder, the average cost of a hearing aid is *,*** euros, which is an average investment of *,*** euros for people who have equipped both ears (***) and the average renewal time for a hearing aid is * and a half years. Behind this average price is actually a different range of prices that can go from a few hundred euros to over *,*** euros

Breakdown of hearing aids by price range France, ****, in percent

Source: ****

There are three different types of hearing aids

L' entry-level This is a range of functional appliances with a simple design and limited services; The mid-range market These include more elaborate devices (***) The high-end This is a group of devices with advanced technologies (***)

Price per type of device :

The price of in-the-ear hearing aids starts at around **€ for the most basic models, and then expand to a full price range from ***€ à ****€ the price of the device varies according to the technical specifications and the autonomy offered.

BTE prostheses are available in a wide range of sizes and can cost more than €*,***, with prostheses such as Phonak's Naida V** UP, sold at a price of **** The price of the Beurer HA** prosthesis is around €**. Intermediate ranges exist on a ...

4.3 A shortage of hearing aid practitioners which increases the cost of hearing aids

According to the consumer association UFC Que Choisir, the shortage of hearing aid professionals has resulted in particularly high gross margins for the profession, in the order of **%, which is responsible for the high prices of hearing aids, but also for the fact that part of the population has given up trying to buy them.

Breakdown of income related to a hearing aid France, ****, € Source: ****

This high margin also allows hearing care professionals to generate significant net margins, which are expected to decrease as new players enter the market. However, salary costs remain significant, representing around **% of hearing aid practitioners' costs [***].

Breakdown of the gross margin for a hearing aid France, ****, € Source: ****

The shortage of professionals in hearing aids forces high payroll costs, around *** euros on average per device. For the Competition Authority in its July **** report, this shortage of hearing aid professionals comes from a numerus clausus of hearing aid professionals in universities that does not evolve with the growing needs of the demand. [***]

The following summary explains the details of the prices according to the different ranges of the market:

Source: ****

The cost R The production process of audio prostheses includes several stages, with upstream work of Research and ...

4.4 Hearing aid accessories

Hearing aids are available to provide more comfort to users:

TV connectivity accessories to transmit sound directly to hearing aids Accessories for rechargeable batteries Smartphone accessories for sound in hearing aids or for remote control of hearing aids Maintenance accessories such as cleaning sprays or damp-proofing tablets

Examples of accessories, found on unison Laboratory :

Headphones with special tips Protective device for hunters or motorcyclists, for example, which attenuates external noise Protective end caps to seal the devices Noise protection Shoes for connection to FM accessories Hearing glasses Portable microphones Wireless remote controls to control hearing aids remotely

5.1 Regulatory framework for the hearing aid market

The National Union of Audioprosthetists offers a reminder of the profession's current regulations on its internet site .

Access to the profession of hearing aid acoustician and its practice are governed by a set of laws, decrees and orders that are codified in the Public Health Codes (***)

There is also a national agreement between health insurance organisations and hearing aid practitioners which was set by decree of ** August **** .

Compliance with these laws and obligations imposed on hearing aid practitioners is verified by the DGCCRF which is responsible for monitoring compliance with the standard quote "including ensuring that the consumer is able to know and understand the price of all the items invoiced in the fitting and follow-up of hearing aids in order to better compare, without difficulty, different offers.

Hearing aid estimates must be drawn up by professionals (***) according to a ministerial order of October **** .

5.2 Coverage of hearing aids: the 100% Health reform

The health insurance reimburses, on medical prescription, hearing aids and their accessories. The reimbursement depends on the age of the patient and the severity of his or her hearing impairment. There are two classes of hearing aids, Class I covers the so-called essential hearing needs and Class * covers hearing aids that meet more demanding needs.

Supplementary health insurance companies make a significant contribution to the reimbursement of hearing aids. The amount covered by these supplementary health insurance policies varies according to the contracts taken out. They generally offer a fixed price for the purchase of each device or a financial contribution. The amount then corresponds to a percentage of the Social Security's Base de Remboursement (***).

A hearing aid reimbursement simulator has been set up by Unisson Laboratories and is available at next .

***% Health reform:

The government has classified products as "***% Health". For these products, the Health Insurance and your responsible mutual insurance company reimburse the entire cost. There will be no remaining expenses, this is called the "RAC *" or zero remaining expenses. The government has implemented the RAC * in the dental, optical, but also audiology sectors. As of January *, ****, the out-of-pocket costs for hearing aids have decreased and the reform ...

6.1 Segmentation

• Sonova Groupe
• Prodition (Groupe Demant)
• Starkey
• WS Audiology (Widex Sivantos)
• GN Hearing
• Unitron (Sonova Groupe)
• Audika (Groupe Demant)
• Amplifon
• Alain Afflelou Accousticien
• Audition Mutualiste
• Krys Group
• Demant groupe