Transcript MarkeTrak V Hearing Aid Industry Market Tracking Survey

MarkeTrak V
Hearing Aid Industry Market
Tracking Survey
Sergei Kochkin, Ph.D.
Knowles Electronics, Inc.
June 1999
MarkeTrak Topics
• Demographic indices & trends
• Customer satisfaction revisited
• Hearing aids in the drawer
• Subjective benefit
Demographic Indices
• National family opinion panel
– 80,000 households
– 13,492 hearing-impaired households
• Detailed questionnaire 2,720 hearing aid
owners.
• Response rate 83%
• No new survey to non-owners in MarkeTrak
V.
Hearing Aid Market Penetration
25
% Penetration
24
23
23.8
22.9
22
22.6
21
21.3
20
20.4
19
18
1984
1989
1991
1994
1997
Hearing-impaired User &
Non-user Population
Non-users
25
Non-owners
21.7
20.6
20
19
20
Millions
Users
15
10
5.1
4.9
5
0.8
1
0.7
4.7
4.6
0.9
0
1989
1991
1994
1997
Hearing Loss Population by Age Group
Owners versus Non-owners
85+
Owners
Non-owners
75-84
65-74
55-65
45-54
34-44
18-34
<18
0
1
2
3
Millions
4
5
Clinton Announcement Spurred “Baby
Boomer” Potential Market Growth
5.5
Millions
5
4.5
4
1994
1997
3.5
3
3444
4554
5565
6574
75+
• Clinton news
release 10/97.
• Survey taken 11/97.
• Age 45-54 hearing
loss growth =23%
• $60k growth =35%
• Some college
growth = 30%
Physician Screening for Hearing
Loss During Physical Exam
25
Percent screened
20
15
HIA Targeting with Physicians
20.2
18.8
16.3
15.1
18
16.6
16.6
10
5
0
May-89 Nov-89 May-90 Nov-90 Jan-92 Jan-92 Dec-97
Binaural Penetration Trend
90
80
Total Owners
70
Total Owners - Current
60
Bilateral loss Ss - Current
79
70
65
61
50
65
60
52
51
47
40
37
30
20
79
22
25
10
0
1984
1989
1991
1994
1997
Hearing Instrument Fittings by
Perceived Profession
70
1984
1991
1994
1997
Percent of fittings
60
50
40
30
20
10
0
Audiologist
Physician
H.I.S
Other
Hearing Instrument Fittings by
Source of Distribution (1997)
% purchases
0
10
20
30
40
Audiology office
Hearing aid store
ENT office
VA
Home
Family Dr.
Perhaps one to watch
Other
Hospital
Department store
Clinic
Military
Mail
1997
1994
Third-party Payment Trend
30
% of sales
25
20
15
10
20.4
22.2
1984
1984
23
21.1
27.5
16.2
5
0
1989
1991
1994
1997
Dollars
Average Retail Price
to Consumer
1000
900
800
700
600
500
400
300
200
100
0
+24%
+11%
+30%
+12%
1989
1991
1994
1997
Total
BTE
ITC
ITE
% of sales
Age of Hearing Instrument
50
45
40
35
30
25
20
15
10
5
0
Mean age of
instruments:
1991 = 3.1 yrs
1994 = 3.7 yrs
1991
1992
1997
1997 = 3.8 yrs
<2 yr
3-4 yrs
5-6 yrs
7-8 yrs
9+ yrs
First Time User Rate
60
Eddie
Albert Ads
53.4
Percent of sales
50
FDA/FTC
40.5
40
39
29
30
20
10
0
1989
1991
1994
1997
Factors Influencing New
First Time Users to Purchase
% New users
63
53
26
10
11
11
13
Family
Doctor
HA Owner
ENT
H.I.S.
Audiologist
Family
H.L. worse
70
60
50
40
30
20
10
0
• Factors less than 10%
mentions:
– Free HA (7%)
– Price (6%)
– Ad-magazine (5%)
– HL Literature (3%)
– Boss/co-worker (3%)
– Newspaper (2%)
– Direct mail (2%)
– Ad - TV (1.5%)
Physician
Recommendation Trends
30
Family
ENT
% of new users
25
20
15
10
5
0
89
91
94
97
• 1989 - HIA advertising
to physician.
• Current initiatives:
– Mfg. screening kit
– BHI - physician
handbook
– BHI - Academy of
Family Physicians
– AAA Best Practice
• Family doctor (Positive)
• ENT (Negative)
Key Trends
• Negative trends
– hearing aid penetration
• Static trends
– hearing screenings by physicians
– distribution penetration
– Binaural penetration
Key Trends
• Positive trends
– third party payment
– first time users
– repeat purchase
– retail price (??)
– Clinton - motivation of “Baby Boomers”
• 1 million new potential customers
Customer Satisfaction
Revisited
Topics
• Trends 1991-1997 (1-5 years old)
• Segmentation (1-5 years old)
• Publishing of new research norms (3-12
months old)
• Hearing aids in the drawer (total)
Method
• MarkeTrak Survey
– 4 behavioral items (hours, repurchase)
– 1 Quality of life
– Likert Satisfaction Scale
•
•
•
•
8 Product features
12 Performance/value
13 Listening situations
6 dispenser attributes
– Modified APHAB (21 point scale = 5%)
% Satisfaction
Customer Satisfaction by Age of
Hearing Instrument
80
70
60
50
40
30
20
10
0
73
63
<3 mo. 4-6 mo.
60
7-12
mo.
59
58
2 yr.
3 yr.
53
53
53
4 yr.
5 yr.
6 yr
Age of hearing aid
43
42
7-9 yr. 10+ yr.
Amount of Time Spent Counseling
New Users of Hearing Instruments
35
% new users
30
25
20
15
29.4
23.3
10
5
0
20.1
11.5
2.6
None
0.25
0.5
0.75
1
Time spent in counseling (hours)
7
6.1
2
3+
Customer Satisfaction as a Function of
Time Spent with New Users
% satisfaction
80
70
60
50
40
30
20
10
0
45
65
68
55
59
0.5
0.75
1
2
13
None
0.25
Time spent in counseling (hours)
Overall satisfaction
Multiple Environmental Listening Utility
(MELU) is Critical to Satisfying Consumers
100
90
80
70
60
50
40
30
20
10
0
0
1
2
3
4
5
6
7
8
9
10
Number of listening situations satisfied
11
12
13
Satisfaction (%) with Benefit
Perceptions of Benefit as a Function of Multiple
Environment Listening Utility (MELU)
100
90
80
70
60
50
40
30
20
10
0
0
1
2
3
4
5
6
7
8
9
10
Number of listening situations satisfied
11
12
13
Quantifiable Client Oriented
Scale of Improvement (COSI)
• MarkeTrak measures satisfaction in 13 listening
situations (5 point scale).
– Very Satisfied (+2) to very dissatisfied (-2)
• Also “Importance” of hearing in these 13 listening
situations (0-3 point scale)
– Not important (0) to very important (3)
• Score = Satisfaction x importance
• Total score = Sum (all situations x need)/Total
possible score
Quantifiable COSI - Strong
Predictor of Perception of Benefit
100
90
80
70
% Very 60
50
satisfied
40
30
20
10
0
-50- -1100 49
0
10
20
30
40
50
60
COSI (% Need Met)
70
80
90
100
U.S. Customer Satisfaction Trends
No significant differences (H.A. 1-5 years.)
70
Positive
Negative
% Satisfaction
60
50
40
30
60
59
57
20
18
10
17
15
0
1991
1994
1997
% Satisfaction
U.S. Customer Satisfaction New
Hearing Instruments (<1 year)
80
70
60
50
40
30
20
10
0
Positive Negative
71
66
63
12
1991
7
1994
10
1997
• Declines (+5%)
– Battery life
– Adjust. V.C.
– Value ($$/performance)
• Gains (+5%)
– Visibility
– Localization
– Outdoors
– Place worship
– Telephone
– Post fitting service
Customer Satisfaction Trends
• MarkeTrak V significantly higher than:
– MarkeTrak IV (1994) :
• 23 of 33 items (p<.01)
– MarkeTrak III (1991):
• 4 of 33 items (p<.01)
Customer Satisfaction Trends
• Key improvements (1997 vs.1991 & 1994):
– Outdoor enjoyment
– Phone usage
– Value
– Explain care of hearing aids
• Visibility ratings are lower than in 1991
The introduction of CICs Probably Caused
Post-purchase Cognitive Dissonance with
Visibility of Instrument
90
% Satisfaction
80
1991
1997
70
60
50
86
79
73
67
62
57
60
40
30
BTE
ITE
ITC
CIC
Satisfaction Segmentation
•
•
•
•
•
•
•
by type of hearing loss
by style of hearing aid
Programmable/non-programmable
Telecoil
Hearing aids without volume controls
New user versus repeat user
Binaural versus monaural
Overall satisfaction
by Style of Hearing Aid
66
ITC/Invisible
56
ITC/Visible
57
ITE/Partial
58
ITE/Full
61
BTE
50
52
54
56
58
60
% Satisfaction
62
64
66
68
Satisfaction by Style
of Hearing Aid
• CIC rated superior on 15 attributes.
– Visibility
– Comfort with loud sounds
– Listening situations (7 of 13)
• Telephone, Outdoors, workplace,
Groups, restaurant
• CIC rated lower on battery life, V.C.
– 34% w/o a V.C. want one
Satisfaction by Style
of Hearing Aid
• BTE rated significantly lower:
– Ability to hear soft sounds
– Difficult listening situations
– Tell direction of sounds
• BTE rated higher
– Hours worn
– Battery life
• Are lower ratings due to degree of loss?
Degree of Hearing Loss
Customer Satisfaction by
Perceived Level of Hearing Loss
Profound
66
Severe
58
Moderate
60
Mild
48
0
10
20
30
40
% Satisfaction
50
60
70
Customer Satisfaction by
Perceived Level of Hearing Loss
• Mild loss significantly lower on 13
attributes
– Quality of life
– Likelihood of repurchase/recommend HA
– Wearing of aids
– Perception of benefit
– One-on-one communication
Customer Satisfaction by
Perceived Level of Hearing Loss
• Profound lower on 15 attributes:
– Perceived benefit
– Fit and comfort
– Ability to hear soft sounds
– Localization
– Whistling/feedback
– Nearly all listening situations
• Yet, they give the highest overall rating.
What about the volume control?
• 9% report they have
none.
• 37% want one.
• Big differences on
satisfaction.
• Should make sure
consumer can live
without a volume
control.
% Satisfaction
Overall Customer Satisfaction
100
90
80
70
60
50
40
30
20
10
0
82
Don’t
Need
VC
52
49
Not
sure
Need
VC
The Binaural Advantage
(Rated higher on 15 attributes)
8
8
8
Concert/movie
Church
Sound of voice
9
9
Car
Outdoors
11
11
Small groups
Able to hearing soft sounds
14
Localization
3
Overall
0
2
4
6
8
10
12
% Satisfaction (Difference score)
14
16
The Telecoil Advantage
(Rated higher on 8 attributes)
9
Recommend HA
10
Outdoors
11
Quality of life
12
Whistling/feedback
18
Telephone
2
Overall
0
5
10
15
% Satisfaction (Difference score)
20
The Programmable Advantage
(Rated higher on 37 attributes)
13
Car
14
14
Telephone
Noisy situations
15
15
Warranty
Place of worship
16
16
16
Small groups
Whistling/feedback
Comfort/loud sounds
10
Overall
0
5
10
15
% Satisfaction (Difference score)
20
New Users More likely to be
Dissatisfied with Their Experience
• 54% overall satisfaction new users
– versus 63% for repeat users
• New users rate 16 items lower
–
–
–
–
Quality of life (-21)
Recommend hearing aids (-12)
Repurchase , reliability (-10)
Battery life (-8)
• New users rate 5 items higher
– Able to hear soft sounds (+10), Large group (+7)
Key Findings
• Modest improvements since 1991
• Major improvements since 1994
• Strong advantage in favor of
– Programmable
– Telecoil
– Binaural
– CIC
• Mild hearing loss & new users less satisfied
Key Findings
• CIC introduction - probable negative impact
on larger instrument satisfaction.
• Lack of a VC could depress satisfaction for
some segments of users.
• Importance of:
– Counseling time spent with consumer
– Multiple environmental listening utility
(MELU)
– Volume control to some users of CICs
Hearing Aids in the Drawer
Methodology
• Consumers who own a hearing aid but
NEVER wear it = hearing aid in the drawer.
• Hearing aids in drawer = 16.2%
respondents.
• Told to explain why non-use in MarkeTrak
survey.
• Received 348 letters.
• Content coding yielded 567 comments.
Percent in drawer
Hearing Aids in the Drawer are
Related to Age of the Instrument
40
35
30
25
20
15
10
5
0
5
8
14
15
20
23
20
29
36
32
1
2
3
4
5
6
7
8
9
10+
Age of hearing aid (years)
907,120 Customers do not Use
Their Hearing Instruments
120
325,000 1-4 years
100
80
Volume
60
(000)
40
20
0
1 2 3 4 5
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age of hearing aid (years)
Reasons for Non-Use
• Poor benefit (30%) - 268,507
Reasons for Non-Use
Poor Benefit
• “I threw it away it was worthless to me”
• “I don’t see much difference with them. I feel I
was sold one under false pretense. Don’t feel I
really needed one”
• “There is no improvement in my hearing with the
aids. Where there is a slight improvement in my
hearing, it is minimal.”
Reasons for Non-Use
Poor Benefit
• “I don’t wear the aids at all. The problems
appears to be clarity of words. Volume is
OK but I can’t distinguish words”
• “I have not been able to wear the H.A.
since the day I received it. It was made
wrong and the Company said there was
nothing wrong with it.”
Reasons for Non-Use
Poor Benefit
• “It is not worth the trouble or expense for the
small difference in hearing. I wish I had my
money back.”
• “_____ aims at taking old people’s money for
little value.”
• “All the aids do is amplify the sound that I
can’t discriminate with an aid in the ear.”
Reasons for Non-Use
Poor Benefit
• “When ______sold me the H.A., I was
confident it would help me hear better.
When I received it and wore it every day, it
did not make my hearing any better. So, I
don’t wear the HA and feel like I wasted
my money. I tried to return it and the
person did not seem to want to help me. I
am quite dissatisfied with the whole
experience.”
Reasons for Non-Use
Poor Benefit
• “I can’t hear high pitch sounds with the
behind the ear model.”
• “H.A.s amplify everything but human
voices which is what you need to hear.”
• “____plugs are not worth the price.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
Reasons for Non-Use
Background Noise
• “I will not wear my H.A. because it increases
background noise. And therefore, after a
while I get a headache and get somewhat
nervous.”
• “It catches all the sound on the road, TV, etc
at the same time.”
• “Background noise is distracting.”
Reasons for Non-Use
Background Noise
• “H.A.s don’t work when there is a lot of
background noise. This is when you need
them to work.”
• “Background noise really drives him crazy.”
• “My problem is with background noise. All
my H.A.s do is amplify so they are of little
help.”
Reasons for Non-Use
Background Noise
• “I don’t wear my H.A. because I need it at a
dance, restaurants, and large groups. All
the H.A. does is increase all sound
including background sounds. No help.”
• “Sudden loud noise is a killer.”
• “H.A. amplify other sounds so much that I
actually feel pain.”
Reasons for Non-Use
Background Noise
• “If someone drops a spoon on the table it
is like a rifle going off.”
• “Hate them. They don’t work for me. All
sounds are amplified. Never knew there
were so many. I can’t adjust the H.A.
constantly to every noise.”
Reasons for Non-Use
• #1. Poor benefit (30%) - 268,507
• #2. Background noise (25%) - 229,383
• #3. Fit & Comfort (19%) - 169,431
Reasons for Non-Use
Fit & Comfort
• “My hearing aids are too big for my ears.”
• “It is uncomfortable and my wife says I
don’t listen to her anyway.”
• “It hurts my ears.”
• “I do not like the feel of it in my ear.”
Reasons for Non-Use
Fit & Comfort
• “I don’t wear my H.A. because they plug up
my ears and feel uncomfortable.”
• “My H.A. has the tendency to fall out when
I am working hard in hot weather.”
• “It’s hard to keep it in my ear. I travel for
business a lot and can’t risk it falling out of
my ear.”
Reasons for Non-Use
•
•
•
•
#1. Poor benefit (30%) - 268,507
#2. Background noise (25%) - 229,383
#3. Fit & Comfort (19%) - 169,431
#4. Negative side effects (11%) - 99,048
Reasons for Non-Use
Negative Side-effects
•
•
•
•
•
•
•
Ears that hurt
Too much pressure in the ears
Blisters in ears
Rashes in ears
Itching ears
Dizzy
Nervous
Reasons for Non-Use
Negative Side-effects
•
•
•
•
•
•
•
Ears that sweat
Builds up wax in inner ear
Headache
Hair gets caught in hearing aid
Infections in ear
Problems chewing or swallowing
Plugs up ears
Reasons for Non-Use
•
•
•
•
•
#1. Poor benefit (30%) - 268,507
#2. Background noise (25%) - 229,383
#3. Fit & Comfort (19%) - 169,431
#4. Negative side effects (11%) - 99,048
#5. Price & cost (10%) - 93,839
Reasons for Non-Use
Price & Cost
• “I bought the H.A. when I was teaching. I
had trouble hearing student’s questions.
Since retiring I have stopped using them.
They were costing too much for what good
I was able to get from them.”
• “Programmable H.A. would be desirable
but they cost too much.”
Reasons for Non-Use
Price & Cost
• “My current H.A. are broken & I am
unable to afford the cost of a replacement.
They are too old for service.”
• The expense of owning and maintaining
are too great.
• HMO does not cover for HA. Price is high.
Reasons for Non-Use
Price & Cost
• “I enjoyed my H.A., but they burned up in a
house fire and I can’t afford another one.”
• “I wish an aid would be developed to allow us
to hear natural sound and an aid with a
reasonable price.”
• “If I could afford it, I would buy a different
brand.”
Reasons for Non-Use
Price & Cost
• “My H.A. was never dependable. Taking it
in for an adjustment was only a headache
as it never performed very long. Had to be
looked at again. The last time I had
trouble, the office wanted to send it to
_____ at $200 & just to check it, plus
another $200 to repair it.”
Reasons for Non-Use
•
•
•
•
•
#1. Poor benefit (30%) - 268,507
#2. Background noise (25%) - 229,383
#3. Fit & Comfort (19%) - 169,431
#4. Negative side effects (11%) - 99,048
#5. Price & cost (10%) - 93,839
• #6. Don’t need help (8%) - 72,987
Reasons for Non-Use
Don’t Need Help
• “I work and live alone and do not need the
aid most of the time.”
• “I had an operation on my right ear and I
can hear better again.”
• “I don’t talk to anyone during the day.”
Reasons for Non-Use
Don’t Need Help
• “I can hear most everything without
H.A.s”
• I feel I was sold under false pretense. I
don’t feel I really needed one.”
• “Don’t wear very often since my hearing
loss is only 35 degrees.”
Reasons for Non-Use
•
•
•
•
•
•
•
#1. Poor benefit (30%) - 268,507
#2. Background noise (25%) - 229,383
#3. Fit & Comfort (19%) - 169,431
#4. Negative side effects (11%) - 99,048
#5. Price & cost (10%) - 93,839
#6. Don’t need help (8%) - 72,987
#7. Broke or does not work (8%) - 68,814
Reasons for Non-Use
Broke or does not Work
• “After a year, the H.A. is down. I can’t
afford to repair them.”
• “Because it doesn’t work. ______ refused
to do anything. The man that sold it to me
has been fired.”
• “It does not work right.”
Reasons for Non-Use
Broke or does not Work
• “I don’t wear it because after the warranty
expired it got broken. It would cost $1,200
to replace it, so I quit wearing it.”
• “The housing is currently broken and will
have to be glued back together. This is the
fourth time it has broken.”
Reasons for Non-Use
Broke or does not Work
• “It seems as if the aids were in the shop for
repair more than in my ear. They are still
not adjusted correctly for my comfort level.
The cost of the repairs were too much. It
is easier to go without them and have
everyone speak louder.”
• “I have 2 H.A.s that don’t work. It costs
$200 a piece cash to have them fixed.”
Reasons for Non-Use
• #8. Sound quality (6%) - 57,329
Reasons for Non-Use
Sound Quality
•
•
•
•
•
•
•
•
“Never got true sound clarity I wanted”
Uncomfortable sound
Sound of crickets
Unnatural
Distorted
Slight hiss
Tinny
Picks up wind
Reasons for Non-Use
Sound Quality
•
•
•
•
•
Chewing and swallowing noise
Poor fidelity
“Can’t stand sound of my voice”
Hollow sound
Aversiveness of sounds (running water,
sharp sounds)
Reasons for Non-Use
• #8. Sound quality (6%) - 57,329
• #9. Won’t wear - unspecified (6%) - 57,556
• #10. Volume control adjust. (5%) - 44,314
Reasons for Non-Use
Volume Control Adjustments
• “I have trouble adjusting the sound.”
• “Hard to adjust. Every time the phone
rings I have to adjust the volume.”
• “They need adjusting, because the
background noises are annoying.”
Reasons for Non-Use
Volume Control Adjustments
• “They are a bother having to turn up &
down too often.”
• “The volume never stays at setting.”
• “I can’t adjust H.A. constantly to every
noise.”
Reasons for Non-Use
•
•
•
•
•
•
•
#8. Sound quality (6%) - 57,329
#9. Won’t wear - unspecified (6%) - 57,556
#10. Volume control adjust. (5%) - 44,314
#11. Whistling & feedback (4%) - 39,100
#12. Nuisance / hassle (4%) -38,371
#13. Poor service (3%) - 28,673
#14. High frequency Loss (3%) - 26,067
Reasons for Non-Use
•
•
•
•
•
#15. Stigma of wearing (3%) - 26,037
#16. Profound hearing loss (3%) - 23,460
#17. Work in limited situations (3%)-23,460
#18. Uncomfortably loud (2%) - 27,114
#19. Battery life (2%) - 19,186
Reasons for Non-Use
1% or less of mentions
• Does not work on
phone
• Monaural aids
inadequate
• Expectations not met
• Has Tinnitus
• Manual dexterity
• Forget to use
•
•
•
•
•
•
•
Family pressure
Feels like ear plugs
Poor directivity
Low gain
Lost hearing aids
Ear wax problem
Rare social user
Key Findings
• 907k inactive hearing aid owners
• Key reasons:
– Poor benefit
– Background noise
– Fit and comfort
– Cost
– Negative side effects
– Hearing aids broke
MarkeTrak V - Conclusions
• Significant opportunities for improvement.
• Encouraging positive trends.
• Huge opportunity still waiting to be tapped.
• Need to find new marketing methods to
reach “Baby Boomers”.