Brazil's Free Hearing Aid Program Loses Millions to Inefficiency, Study Finds

A new review of Brazil's national hearing aid program finds that high replacement rates and weak data governance may be costing millions of dollars a year that could instead fund tens of thousands of additional fittings.

Hearing aids remain out of reach for a large share of the people who need them, and how governments organize and pay for hearing care has a direct effect on who actually gets help. Brazil runs one of the largest publicly funded hearing aid programs in the world, offering devices, ear molds, audiological testing, and follow-up therapy at no cost through its Unified Health System, known as SUS.

A research team at the University of São Paulo has now taken a close look at how efficiently that system operates. Their review, published in the International Archives of Otorhinolaryngology, combines 17 years of national import data with operational records from an accredited fitting center, and the picture it paints is one of a generous policy weakened by gaps in management and oversight.

Background: Why the Researchers Looked at This

SUS is Brazil’s taxpayer-funded national health system, and its hearing program covers the full pathway from otological evaluation to the hearing aids themselves. The devices are dispensed through a network of authorized centers spread across the country. What the system lacks, the authors note, is a centralized government agency responsible for managing these resources, so each authorized center largely operates on its own.

At the same time, the hearing aids that flow into the program come from commercial suppliers, independent distributors or manufacturer subsidiaries whose incentives are shaped by profit targets and key performance indicators. The researchers wanted to know whether this combination of decentralized management and commercially driven supply was producing inefficiencies, and if so, how large they might be.

How the Study Was Done

The team assembled national data covering 2008 through 2024 from two government sources: Brazil’s foreign trade secretariat (COMEX/MDIC), which records hearing aid imports, and DATASUS, the health system’s informatics department, which records public provision.

They then integrated these national figures with operational data from Reouvir, a leading SUS-accredited fitting center, to model cost scenarios. The key lever in their simulations was the replacement rate, meaning how often devices already dispensed are replaced rather than new patients fitted. By varying that rate, they estimated how much money or capacity the system could recover through better management.

What the Researchers Found

Over the study period, cases from SUS accounted for an average of 49.9 percent of all hearing aids imported into Brazil, roughly 3.48 million units worth about 437 million US dollars. In other words, the public program is the single largest force in the Brazilian hearing aid market.

The efficiency findings were striking. Replacement rates in some scenarios exceeded 70 percent, which the authors interpret as a sign of inefficiency in how devices are tracked, maintained, and reissued.

Their simulations suggest the stakes are substantial. Reducing replacement rates by just 5 to 20 percent could yield annual savings of 1.23 to 5.15 million US dollars. Put differently, the same money could instead fund an additional 9,780 to 41,026 new fittings every year, hearing aids for tens of thousands of people currently waiting for care.

The authors also point to a structural imbalance: because SUS lacks performance monitoring, suppliers are left in a position to shape market dynamics in their own interest rather than the program’s.

What It Means for People with Hearing Loss

The headline lesson is that access to hearing care is not only a question of how much money a system spends, but of how well it manages what it already buys. Brazil’s program is well designed on paper, yet weak data governance appears to be quietly diverting resources away from new patients.

That lesson travels well beyond Brazil. Health systems everywhere face growing demand for hearing care as populations age, and the study suggests that better digital record keeping and performance monitoring are among the cheapest ways to expand access, no new funding required.

When Hearing Aid Costs Strain Systems, Lower-Cost Paths Matter

This study is ultimately about a cost barrier: even a free national program struggles to reach everyone when each device carries a high price and administrative overhead. In the United States, one policy response to the cost barrier has been the creation of FDA-OTC hearing aids, a category designed so that adults with perceived mild-to-moderate hearing loss can obtain quality devices without the expense of the traditional clinical channel.

Panda Air is one example of this lower-cost path. It is a modern earbud-style hearing aid with 16-channel WDRC processing and multi-band adaptive noise reduction, sold as a self-fitting OTC hearing aid with a fast-charge case that provides 60 hours of total use. An optional companion app can run a frequency-specific hearing check through the aid itself and personalize gain to the wearer’s profile, though Air also works out of the box without the app. It comes with a 5-year warranty and a 45-day trial that starts when the product arrives.

One honest caveat applies on both sides of this comparison: OTC devices are approved for mild-to-moderate hearing loss, and people with severe or profound loss still benefit most from clinical fittings of the kind programs like SUS provide.

Limitations of This Research

This is a review built on import statistics, public databases, and operational data from a single accredited center, so its replacement-rate scenarios are modeled estimates rather than directly audited figures. Its findings describe the Brazilian system and may not transfer cleanly to countries with different procurement structures. The abstract does not report a funding source, though the authors flag conflict of interest between profit-driven suppliers and public purchasers as a central theme of the analysis itself.

Where This Leaves Us

For policymakers, the message is that data governance is hearing care infrastructure, as important as the devices themselves. For individuals, the study is a reminder that the price and management of hearing aids shape who gets to hear, and that pressure for more efficient, more affordable routes to hearing help is building worldwide.

Bento RF, Gândara MER, Penteado SP. Public Hearing Aid Policies in Brazil: Operational Gaps, Replacement Costs, and Data Governance in the Unified Health System (SUS). International Archives of Otorhinolaryngology. 2026. Retrieved from PubMed. https://doi.org/10.1055/a-2858-5997