'nuff said

So even at 140, even ignoring those that cannot be helped by hearing aids and those that cannot afford hearing aids, the truth is that far more than 140 out of 1,000 people buy the products you mentioned. If you move a higher volume, you can price them lower and approach their true cost as your design and overhead costs diminish with numbers. What's more is that "a laptop" will more or less work for me the same as it will work for you. We don't need to mold the laptop to put it in our ears or have it tuned to our needs.

You also seem to overlook two factors: as electronics get smaller they get more expensive. The second part is that as electronics need to power themselves and get smaller they get even more expensive. And on top of that, my cell phone puts out a lot of heat. The kind of heat I would not want in my ear. So you have to consider that the battery must be small and must not dissipate tons of heat and so therefore the electronics must have a very low power draw. There's not much of a conspiracy to find here, it's an unfortunate reality that prevents someone from storming the market with the new better cheaper hearing aid (pending tech advancements).

In my family, we look at chipping in to buy our elders hearing aids for presents, I know the nice ones are crazy expensive.

Yep. No market pressures to lower the price. Sucks if you don't have or can't get insurance.

Most hearing aids are vastly more complicated than just a volume increasing device. They actually take sounds received on certain frequencies and rebroadcast them on frequencies your mom can hear better on. Thus why they are prescription based like glasses.

Here is a more technical and probably more accurate description:
http://en.wikipedia.org/wiki/Hearing_aid

*releases a tortured sigh while rubbing his tightly closed eyes*

I just bought two state of the art power aids from Costco for 2k, so 1k apiece. They seem to be working just fine for me. They probably would have been 3X the price from a conventional hearing aid dealer

From Anthony Watts web site supplying some technical info about hearing aids, in his words:
I wear two ITC/CIC hearing aids with DSP processors built in. Let me tell you a little bit about why they are so expensive. The largest supplier of hearing aids in the USA is Starkey in Minneapolis. I’ve been to the factory, and have experienced the process from start to finish courtesy of the president of the company.
1. Because hearing aids, especially BTE (behind the ear) and ITC/CIC (completely in the canal) types use a single cell 1.5 volt battery, which can drop as low as 1.3 volts through its useful operational life, the amplifier circuits must be of extremely low power consumption and low voltage. The only chip material that works well for this is germanium, which has a diode junction forward voltage of ~ 0.3V as opposed to the ubiquitous silicon used in consumer electronics which has an ~ 0.7V forward voltage. While germanium was once very common for transistors and some early integrated circuits, it has fallen out of favor in the microelectronics hearing aid world. There are only a handful of sources and companies now that work with germanium, thus the base price is higher due to this scarcity. You can’t just take an off the shelf silicon chip/transistor and put it in these aids. Each one is custom designed in germanium. [Added: power consumption is a big issue also, aids are expected to last a few days on a single battery, if most of the power is being used to overcome the forward diode voltage, it gets lost as heat instead of being applied to amplification use.]
2. The process of properly fitting a hearing aid is labor intensive. Custom ear molds must be created from latex impressions, and these need to be fitted for comfort. A small variance or burr can mean the difference between a good fitting mold and one that is painful to wear. Additionally, if the mold doesn’t maintain a seal to the inner ear properly the hearing aid will go into oscillatory feedback. Sometimes it takes 2 or 3 attempts to get the fitting right.
3. On the more expensive aids, labor is involved in doing a spectral hearing loss analysis of the user’s hearing problem, so that the aid doesn’t over-amplify in the wrong frequencies. Just throwing in a simple linear amplifier is destructive to the remaining hearing due to the sound pressure levels involved.
4. Construction of aids is done by hand by technicians, especially with the popular ITC (in the canal) aids. At the Starkey company, a technician is assigned to create the aid from the ear mold, fit the chips and microphone/receiver and battery compartment, and connect it all with 32 gauge wire and make sure it all fits in the ear mold. This can be a real challenge, because human ear canals aren’t often straight, but bend and change diameter. Imagine a room with a hundred technicians sitting at microscopes assembling these. Each is a custom job. There’s no mass production possible and thus none of the savings from it.
5. After the aid is created, then there’s the fitting. This process is also hands on. Getting the volume and the audio spectrum match right is a challenge, and audiologists have to have chip programming systems onsite to make such adjustments withing the limits of the aid. Sometimes aids are rejected because the user isn’t comfortable with the fitting, and then the aids go back to the factory for either a new ear mold, new electronics, or both.
6. There’s a lot of loss in the hearing aid business. Patients don’t often adapt well, especially older people. There may be two or three attempts at fitting before a success or rejection. Patients only pay when the fitting is successful. If it is not, the company eats the effort and the cost of labor and materials. Imagine making PC’s by hand, sending them out to users, and then having them come back to have different cases or motherboards or drives fitted two or three times, and software adjusted until the customer is happy with it. Imagine

So would "my hearing aid shorted out and burned the inside of my ear". Or "everyone runs away when I approach because they are tired of the constant feedback my poorly fitted heading aid emits.". So would "I paid extra for a phone that was hearing aid compatible and this hearing aid doesn't work with it."

MOST insurance policies do NOT cover hearing aides. As a person who's been wearing hearing aides for the last 30+ years, I can guarantee you this. Only if you work for a much larger corporation with a VERY nice benefits package, will you find an insurance policy that will cover your hearing aides - or even a portion of it.

My last pair cost me just shy of $4000. I paid out of pocket since my insurance at the time didn't cover this expense. This is, to date, the second biggest expense I've ever paid, after my car. They were top of the range 11 years ago. I can buy an equivalent model now with the same features from Costco's hearing center now for about $500 each.

Maybe your mum doesn't need the top of the range aides? Try looking for some with fewer features - say only six channels and two or three programs each (one program for normal environment, one for noisy environment, and one for telephone use if she should so desire). You'll save a ton of money.

The other reason why hearing aides are usually so expensive is that not everybody has the same ear shape. All in-the-ear aides are made from a custom mold, which does increase the cost. My dad recently got a behind-the-ear pair that didn't include a custom mold. The tips fit into the canal, similar to a pair of newer earbud headphones. (They still cost him $1200 for the pair though.)

Your mileage may vary. I highly suggest you shop around. Just remember though - you get what you pay for, and always buy the insurance plan on the li'l buggers.

the main downside to the HSA eligible plans is the high deductibles. There is a requirement that your minimum yearly deductible is $1000 to even qualify for the HSA. And often times it is even higher than that.

Yes they are nice especially when your employer matches your contribution up to $xxx amount. I have had one for 2 years now, and while it does help mainly at the pharmacy it can be burdonsome around the start of the year when that high deductible kicks back in. Unless you managed to get some saved up over the later part of the year.

other issue as to why hearing aids costs so much in the US. Once you add "medical" tag to it here you can instantly increase the price 10x.

I see them now too, that hook up with bluetooth to ones cell phone to make talking on those easier.

There's quite a bit of high tech audio processing in these things...and with the research and all, and lets face it...proprietary, patented algorithms and the like....it isn't cheap to make a quality hearing aid these days. They're packing a lot more than just amplification in these tiny units.

One important step is...get with a GOOD audiologist that you can work with...for testing and picking out the ones with the features that work best for you or those that need them.

They are in fact mass produced, only the earpiece is custom moulded and that is done by the doctor.

A friend had to get a pair after his hearing was damaged in Afghanistan, a pair of automatic rifles going off next to your head to kill the scumbag running at you with a RPG.

His hearing aids are identical to the ones you can buy for hunting. Except his has a custom software EQ curve installed for his specific hearing loss.

That's pretty much the only thing you've said that matters. Well that and the fact that most of them are at least partially customized to the patient. Unlike some products which are significantly cheaper in canada because of collective bargaining and our healthcare system refusing to waste money on billing the way the US does, hearing aids are about the same here.

To sell any medical device it goes through layers of scrutiny. My grandfather in india had a hearing aid where he could hear people fine, but he couldn't hear phones. (I doubted his honesty of hearing fine, but he could at least understand what I was saying from another room with a north american accent speaking english even though he spoke hindi as a first language). But it never worked over the phone. Bizarre. Shit like that wouldn't ever be tolerated by a north american consumer, or by a north american insurance system (government or private).

It also depends very much on what problem you have. Some of the cheap hearing aids do work fine if you have one type of hearing loss but not another. If you need a bone conduction hearing aid (Baha branded) you're looking at 3grand, if you need a cochlear speech processor you're taking 5k or more. The term 'hearing aid' covers fairly simplistic devices to very sophisticated ones. If you have a rare or complicated problem expect rare, expensive solutions.

Exactly. In fact, remember those supply-and-demand lines from high-school economics. Basically, your revenue at any given price will be given by finding that price on the demand curve, finding the quantity that it gives you, and you multiply them. The visual way to show this is to make a square with the lower-left corner at (0,0) and the upper-right corner at some point on the demand curve. The area in that square is your revenue. But that is far from your maximum possible revenue. It turns out that, in theory, you could make revenue equal to all of the area under the demand curve. That whole triangle! Usually, that ends up being about 100% increase in revenue.

The way you pull this off is you have to be able to charge $100 from the people who are willing to pay $100 but not $101. And you have to charge $250 from the people who are willing to pay $250 but not $251, etc. In other words, you charge everybody the most that they'll pay. The economics term for this is "price discrimination". Problem is, it's tough to charge different prices from different people. First off, you have the problem of being able to secretly offering different prices to different people. Second, you have the problem of figuring out who's willing to pay more. The internet has made the first problem a non-issue... until people caught Amazon doing it. Remember about 6-7 years ago when someone noticed that, if you went to buy a product on Amazon, and if you were using the same account that you previous used to buy 4 pairs of top-of-the-line Air Jordans, Amazon would quote you a higher price than if your account was used to but Sketchers? Turned out that Amazon was figuring out how "upscale" or how "trailer-park" you tended toward in your purchases, and they could figure out how much more they could squeeze out of you.

An example which is a little closer to the hearing-aid insurance one is that of airline tickets. Ever noticed how it costs so much more to buy a round-trip ticket which does not stay over a weekend? Who would want to not stay over a weekend? Business people. Who's money are they spending? The company's. Are they going to aggressively price-shop or be willing to stay over the weekend for a better price? Nope. So, they can soak the business travelers for more money.

With insurance, it's kinda the same deal. Doctors do have "cash" prices, which they offer to patients who lack insurance, but they can't get too crazy with the price disparity or it'll start looking like insurance fraud.

Hearing aids are Class 1 Medical devices.... that's the same category as a toothbrush. You don't need to vising a licensed dentist with trade lobbyists to get a toothbrush.

This is why you can buy hearing aids off of TV, the internet, all without a fitting, or a clue what you are getting... Kinda scary because an improper fitting/setting can deafen you.

What I tell people when they ask why they are so expensive - cost in making them. Each hearing aid (in the ear/canal) is custom made by hand, if done wrong, it is re-done at full cost, but the customer doesn't pay for remakes (as stated above). Plus the hearing aid isn't "Make everything louder". It's a very complex device. Think of an expensive home stereo, the type with a bunch of sliders. Now shrink that and put it in your ear. Only have hearing loss in the 1.5 khz range? then that is the only thing boosted... or the sound in that range is shifted up or down. Different environment? have the aid automatically adjust from a noisy lunchroom mode to park mode when you walk outside. Add in directional sound detection so the aid knows the voice in front of you is likely the one you are listening to and not the voice behind you... Add in wireless communication between aids to help find the direction where sound is coming from, plus use media streamers to listen to the TV. Do all of that in something about the size (maybe smaller) than a pen cap.

And no, Health insurance doesn't cover hearing aids (most of the time, maybe there is a few, but that is the exception, not the rule).

Chips are small. It's the nature of the device, if you ever enlarged the microprocessor in your computer to a size where the optics in your eyes could see it then you couldn't fit it in your room. The circuit for a hearing aid is a couple of filters and a few op-amps, these can often be placed on he same breadboard with discrete components, not an overly complex circuit.

Micros-processors don't consume much power either. I've spoken with developers in the field and then are designing circuits that loose so little power that the batteries natural discharge rate without load is greater than the power consumption of the device. What this means is that the circuit will have no noticeable impact on the life of the battery. The biggest impact you might have in a hearing aid is the speaker, which is probably where most of the power draw is and possibly most of the cost. But even high quality ultrasonic speakers can be purchased for less than a few hundred bucks and they are the most expensive speakers I can think of.

As for heat, heat is produced by inefficient circuits (yes this means that your hot cellphone or computer is very inefficient), it's just wasted power. When you have transistors operating close to their frequency limit then you will have a lot of wasted power as the transistor starts to operate in an inefficient mode. With the audio spectrum, being only between 1KHz and 40KHz for your average adult i doubt that you will ever see a hearing aid reach this level. Even a micros-processor can achieve several hundred mega Hz without getting hot or suffering for significant heat or power inefficiencies. And these circuits often cost cost a fraction of a cent each to manufacturer, even the expensive ones don't cost more than a few dollars.

Okay how about the molding? Well with 3Dprinters and injection molding having become fairly cheap in the last few decades I can honestly say that these costs are probably no more than a few dollars.

What about development, well this might justify the cost. If they had to custom design a circuit for your specific hearing problem. But since you can pick many of these up with a week I seriously doubt that is the case, because the licensing for that particular device couldn't be approved in that time.

What about licensing and testing? Here is the tricky part this is medical device, so these costs are rather high but it's only a one time cost per device model so this cost should go down for "proven" devices. Even then this shouldn't be that big of an issue as the device is not going inside the body. and as long as they ensure that the device never produces a harmful emission (sound/explosion/battery leakage) the costs should be negligible to the consumer.

So what have we learned? Well the cost should be at most a couple of hundred of dollars probably no more than a quality cellphone, and most of that is because of the speaker for the device. So where do all of these costs come from? I'll leave that up to your imagination. Personally I'd just go down to your local Radio Shack and for about 20-30 dollars in parts (mostly the headphone cost.), an Altoids tin, and some circuit design knowledge, you could get the same product, just a little bulkier. If you ordered the parts online you could get them cheaper and of higher quality. Since i already know how to do all of this I'll let you guess the route I'll take. Heck i already have everything I need in my tool closet.

I'm a very satisfied customer.

Definitely there's more paperwork involved with a Class 1 medical device than say a DVD player, but if both manufacturers follow good management and development practices, it's not really that much more paperwork.

If a persons hearing in each ear is charted, frequency versus sensitivity you fine a lot of variation in people with hearing loss at various frequencies caused by various legal and not legal drugs, loud music, impulse noise from Guns of jets etc. The hearing aid is then programmed to boost/cut various frequencies to get as close as possible to the natural ear with no deficiencies. They have built in equalization. The better the resolution of this equalization and the better the job the audiologists do and the better hearing aid purchased = best results. The hearing aid itself has a base cost of about $50, plus fees to program each one, test with the person in a quiet room, fit to the ear drum shape etc, all adds cost. Low power, more efficient units cost more = last longer on smaller battery

That said, there are many ripoffs out there, and many locked up distribution channels by people who want to sell a $50 item for $2000. Hearing loss forums can help, but they get a lot of manufacturers shills in there, takes a while to know the crooks.

Familiar with duplexer tuning, however a hearing aid is mono-directional, and as solidraven (1633185) says, determining the gain versus frequency profile should be quick. Frequencies that have gone fully deaf - no cochlear hairs left, will probably not be compensatable with an external device, we can directly stimulate the nerves with a cochlear implant, after which the person learns to hear anew. Here is a simple youtube about it http://www.youtube.com/watch?v=SmNpP2fr57A [youtube.com], the comments are also of interest. This search is also useful http://tinyurl.com/cq8bz3w [tinyurl.com].

It is my understanding that you can buy the programmable chip that is a complete processor heart of a hearing aid from many makers. Here is another search on that topic.
http://tinyurl.com/cwcuwuq [tinyurl.com].

Even more "Bogus" in that you can get the SAME Siemens #2000.00 hearing aid (US) in Singapore for $180.00 (US).