According to information gathered by the German, Dutch and UK contributors, there are large differences in rehabilitation procedures between the countries. SOme differences are due to different service structures and philosophies. In the UK there are two separate services, one within the state-funded National Health Service (NHS), and the other in the private sector. Within the NHS the provision of hearing aids and associated services is fully state-funded. The procedures used in the NHS are nationally determined, and have been developed from a Health Services Research base reflecting both scientific and medical views and the views of audiologists working in the NHS. In the private sector the costs are met wholly by the individual receiving the hearing aid. There is a nationally agreed code of practice for professionals in the private sector, but this concentrates more on professional conduct than specifics of rehabilitation tests and procedures. In other countries, insurance schemes require certain tests to be carried out at fitting to prove benefit, in order for costs to be claimed for the hearing aid. In the UK NHS system, because there are no costs to the recipient, the approach of assessing benefit is not the same as in other countries. For example, in the UK speech intelligibility tests are not usually performed during hearing aid provision and the approach used to assess benefit is by looking at a client’s everyday life using a questionnaire. In Germany, however, speech intelligibility tests (mostly in quiet) are used to indicate the benefit of the hearing aid.
In the Netherlands, the hearing impaired person goes to a medical audiological centre for diagnosis and prescription of a suitable hearing aid or aids (covering both type of aid and a first pass at the setting of the aid for the individual). Then they go to a professional hearing aid dispenser who issues and fine-tunes the hearing aid(s). The hearing-impaired person returns to the audiological centre for evaluation measurements. From 2004 on, clients have been allowed to bypass the audiological centre and go straight to a hearing aid dispenser. Hearing aids themselves are (partly) paid by health insurance.
The Dutch system is similar to the German system. In Germany, the hearing impaired person has to visit an ENT doctor for diagnosis. Then they go to the hearing aid professional to get hearing aids fitted and fine-tuned. Since fitting is performed by the hearing aid professional, the professional also performs all unaided measurements that are needed for fitting. The hearing impaired person has to return to the ENT doctor to get a reimbursement from health insurance. As in the Netherlands, hearing aids themselves are (partly) paid by health insurance.
In order to confirm the status quo in hearing aid rehabilitation, a questionnaire was produced to be sent out to hearing aid professionals (open/download the questionnaire : German version translated into English). It covered different aspects of the fitting process: influence of earmould, fitting rules (proprietary and generic rules), verification measurements, fine tuning, intention for fitting (e.g. maximizing intelligibility or normalization of loudness perception).
Optimal rehabilitation procedures
An achievable optimum in rehabilitation procedures should take account of the gap between the ‘ideal’ and ‘real world’. Since the ‘real world’ is rather different in different countries (as shown by the comparison of rehabilitation procedures), the gap will also differ between countries. Professional's views of the "ideal world" were in part informed by a focus group of German audiology professionals .
Dutch, Englsh and German partners' views on good practive were collected to cover:;
The ideal procedures under these sub-headings as presented in the following table represent both broadly shared opinions across different countries, and some distinctive proposals advocated by each partner. The UK response is based on the view that current best practice in the UK within the state (NHS) sector has been established very recently by the state funded “Modernising NHS Hearing Aid Services” programme, which was based on considerable research - see http://mhas.ihr.mrc.ac.uk/index.html.