Hearing Aids Manufacturing: A Sustainable Oligopoly? | In Practise

Hearing Aids Manufacturing: A Sustainable Oligopoly?

Former Managing Director, Sivantos

Learning outcomes

  • The pros and cons of vertical integration for OEMs
  • How barriers to entry to the hearing aids OEM market have evolved over the last 20 years
  • Threat of new entrants: Apple & Samsung
  • Reasons average selling prices for hearing aids would further erode in the coming years
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Executive Bio

Robin Hees

Former Managing Director, Sivantos

Robin spent over 15 years in the hearing aids industry, starting as a salesperson in the hearing instrument wholesale business for Siemens Audiologische Technik (Now WS Audiology). His service at Siemens’ hearing aids business culminated in the role of Managing Director for 5 years, from 2011-16. He is currently the CFO of Method Park, a fast-growing software engineering consultancy headquartered in Germany. Read more

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Tell us a little bit about your relationship with the hearing aids industry.

I’ve been working for roughly 15 years in the industry, starting as a salesperson in the hearing instrument wholesale business for one of the big players, namely Siemens Audiologische Technik. I made a career through various functions and left the industry after the sale of that business to a private equity investor when Siemens divested it. In the last few years, I’ve been working as Managing Director of Siemens Audiologische Technik.

Could you describe the journey of a unit of production of a hearing instrument, from the production floor to being fitted on a consumer?

Yes. Let me frame this by saying that a hearing instrument 100 years ago and today still basically, consists of the same contents. You need a microphone/s, a receiver, an amplifier – which is digital nowadays – and you need some energy, a battery or an accumulator. These are the basic ingredients of a hearing instrument. The way it is developed further and is also produced has changed a lot.

You have to understand that the parts of the hearing instrument are purchased from suppliers. The real know-how that’s inside of the hearing instrument is basically signal processing, the audio processing. So the hearing-impaired person gets the amplified tones, speech, whatever signal, in real time, in good quality and amplified in a way that is matching the individual hearing loss.

Having said this, hearing instruments are basically a technical audio device. They are produced in a kind of mass production. There are only very few spots still in Europe; most of the factories are in Asia. Starkey, for example, still produces in the US. The hearing instrument engine nowadays is still, to a certain extent, the same in a lot of hearing instruments and is then like a car, somehow fitted to the need. You can buy a unit with a full set of features or one with not so many features. But the engine in the hearing instrument is the same and is able to provide all required features.

That makes the production much easier than in former times and, nowadays, a big part of the production is automated. 10 to 15 years ago, many things had to be welded manually in the integrated circuits and the pieces that hearing instruments are made of.

I have a good insight, of course, into the value chain that we had in the company I worked for. Traditionally, from a quite central fabrication and logistics point, these goods are distributed into the world, normally into the local presence of a manufacturer who usually – especially in the past – fulfilled the wholesale function in that market and distributed the hearing instruments to the retailer.

In the past few years, the formation of this market has been consolidated so you find big retail chains that own an enormous number of points of sale. You also have small chains, which tend to be acousticians or small groups that maintain a couple of hearing aid points of sale or dispensers. But you still have a significant number of so-called mom-and-pop shops, which would be a single audiologist or acoustician that performs his business, has one shop, maybe owns the facility and works in the shop himself. With the consolidation, that part of the channel is shrinking and moving more and more towards big retail chains that buy these mom and pop shops in the market.

The hearing impaired – this is now the chain starting from the other side – suffer from hearing loss. The interesting part is that the person who suffers from hearing loss doesn’t really feel that he suffers because, in many cases, he doesn’t really have a problem with that. The opposite is the case; certain background or annoying noises are just not hearable, so at a certain point of time, in many cases, this person gets some pressure from family, from work colleagues, to get his hearing tested.
He goes to an audiologist or to an ENT doctor and normally gets a diagnosis that he has hearing loss which can be classified from mild to severe or profound. Then usually, with a prescription in his or her hand, the patient will go to the audiologist or hearing aid acoustician and both ends of the chain come together; the hearing aid acoustician then combines the device that is manufactured by the big OEMs, with the patient.

This process is a little bit complex. There needs to be a fitting of the hearing instrument to the individual hearing loss of the patient. We’ll come to that point later in the discussion, because there are some dynamics in the market. But I would say, this is the traditional way a hearing instrument goes from the production floor to the patient which means the hearing instrument itself has a few thousand kilometers journey behind it when it arrives on the ear of the patient.

Do the brands of the manufacturers mean anything to the individual customers?

As we talk about brand awareness and brand value, indeed the typical customer is still quite old and relies on the recommendation of either the ENT or the audiologist. So compared to young people who go to an electronic shop and ask for an iPhone or a Samsung, the hearing aid customer goes to an acoustician to get a hearing instrument and they normally don’t have a clue about any brands. In my personal experience, I can say the Siemens brand, especially in Germany and Europe, was quite present and known so this might have helped in a few cases, but this was not really a distinguishing factor.

Once you are a user of a hearing aid, I would say the brand value is an increasing, decisive factor. For example, if you suffer from hearing loss as a child, you get fitted with hearing instruments, you grow with the hearing instruments and when you have been fitted successfully with hearing instruments from a certain brand, there’s a high likelihood to stay with that brand, at least for quite a while. So when you get older and you change the hearing instruments, you are more likely to stick to that brand than change it, unless you are not satisfied with it.

What’s your sense of what customers really care about when selecting a device and selecting between manufacturers?

I don’t know whether it’s still the number one wish but what people often say is, they want a hearing instrument that is not visible; people are concerned how others might react when they see someone with a hearing instrument. Of course, it’s cosmetic and hearing instruments still suffer from a certain stigma. We always said we understand this desire, but there are certain advantages, depending on the hearing loss, as to whether you wear a behind-the-ear instrument or an in-the-ear instrument. In some developing countries, there are also reasons for pocket hearing instruments. They’re not quite state of the art any longer, but still, it is better people wear this than no hearing instrument. It’s more the cosmetic appeal that is interesting, at the very beginning, and not so much the acoustic performance.

To add to this point, many people have the impression that, if you have a hearing loss and you get a hearing instrument fitted, afterwards the hearing loss will be fine; that is wrong. I wear glasses. Glasses are a totally different story. You suffer from a certain loss, you don’t see certain things, you go to the optician, get glasses and immediately you see clearly.

When you get a hearing instrument, normally the patient has suffered for quite a while from a hearing loss, so the brain has started to retrain on other tones. When you get a hearing instrument, technically, you will hear everything again in real time, amplified in a way that it’s reflecting the real tone. This becomes an immense noise to your brain. People tend to say no, because it is so unusual and they feel annoyed by what they hear again.

In some cases, this fitting process lasts three to six, especially due to the fact that people need to retrain their hearing with instruments. This means the instrument cannot be adjusted to the settings according to the hearing loss straightaway, but it needs to be accommodated, step-by-step, to the hearing loss. In the first fitting session, the audiologist would just make a very mild amplification so that the patient gets used to it and starts to retrain again.

How did you look at the question of competitive differentiation in the product while you were at the Siemens business?

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Hearing Aids Manufacturing: A Sustainable Oligopoly?

September 2, 2020

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