Approximately 15% U.S. adults have hearing loss. Among older adults >75, over half live with hearing loss. In a context where Medicare and many state Medicaid programs do not cover audiologist services beyond physician-referred assessments in support of a diagnosis, this study focuses on audiologist service accessibility in the U.S. As the U.S. population ages, the number of adults with hearing loss is expected to double, while the supply of hearing and balance specialists (audiologists) has not kept apace with the needs of the population.
This study applies spatial analytic approaches to (1) identify predictors of audiologist availability and supply at the county level, (2) the effects of audiologist co-location with referring primary care providers on existing racial, ethnic, and class disparities in spatial access to primary care, and (3) analyze associations between county-level per beneficiary Medicare expenditures on hearing loss treatment and outcomes associated with foregone treatment (falls and preventable hospitalizations). Taken together, the findings link health care policies with the spatial arrangement or distribution of care, relative to the distribution of population-level outcomes associated with foregone or delayed treatment of hearing and balance disorders. The findings point to the potential of applying spatial thinking to the study of health and health care equity.
