{
  "abstract": "Cochlear implantation (CI) is a common treatment for children and adults with severe to profound hearing loss. In many countries, children up to 18 years old are offered implants in both ears (bilateral implantation), and this is funded. For adults, however, funding is usually only provided for one implant (unilateral implantation), even though studies show that two implants are also effective for them. This difference in funding raises the question of whether current policy is fair. We argue that the way these policies are assessed needs to change. Rather than treating two CIs as a straightforward medical device evaluated only through standard health metrics, they should be understood as a complex intervention that influences many aspects of life. To evaluate their value properly, we need broader approaches or perspectives that go beyond conventional quality-of-life measures, capture benefits outside the health domain, consider impacts on families and society and place greater weight on people’s lived experiences and real-world outcomes. These perspectives challenge the ontological, moral and epistemological foundations of current evaluative frameworks and advocate for a reconceptualisation of bilateral CI as a complex, multilayered intervention. To adequately capture its impact, broader epistemic approaches are needed, ones that complement or move beyond the quality-adjusted life years model to incorporate benefits beyond health and benefits beyond the recipient of care and give greater weight to experiential knowledge and real-world data.Based on this approach, reimbursement decisions for bilateral CI in adults with bilateral hearing loss should ultimately allow for individualised assessments and shared decision-making with a healthcare provider to account for personalised benefits and limitations. Policy frameworks should integrate personal, societal and ethical dimensions, enabling flexible, patient-centred decision-making rooted in personalised clinical need. In the context of bilateral CI, stakeholders are well-positioned to engage in meaningful dialogue, fostering clinical decisions that support the individual’s flourishing within their unique life context.",
  "authors": [
    {
      "affiliations": [
        "Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands",
        "Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands"
      ],
      "name": "Wendy J Huinck"
    },
    {
      "affiliations": [
        "Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"
      ],
      "name": "Simone Naber"
    },
    {
      "affiliations": [
        "Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands",
        "Theology, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Stef Groenewoud"
    },
    {
      "affiliations": [
        "Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"
      ],
      "name": "Adriana L Smit"
    }
  ],
  "title": "Reimbursement policy decisions for bilateral cochlear implantation in adults: how should they be evaluated?",
  "uid": "7fff8309-4378-5a09-9de3-895b5982eefb"
}