Trends in educational placement and cochlear implantation in Taiwan: impact of national healthcare policies

Aim: This study aimed to explore the potential association between universal newborn hearing screening, reimbursement policy for unilateral cochlear implants, and trends in educational placements and cost implication in Taiwan. Subject and Methods. Government data from the 2009, 2015, and 2021 school years were analyzed to assess changes in educational placements and costs. Individuals with moderate-to-profound hearing impairment were selected from a cochlear implant institute to assess their actual utilization of hearing devices across the three periods. Results: The proportion of students with hearing impairment attending centralized special classes decreased significantly from 25.2% in 2009 to 10.5% in 2021, associated with reduced special educational budget allocation. Over a 12-year compulsory education period, the transition from centralized special classes to decentralized resource rooms was estimated to save approximately US $100,000 per child with hearing impairment. Between 2009 and 2021, a notable increase in cochlear implant use was observed, particularly after the 2017 policy change that reimbursed cochlear implant expenses. Conclusion: The data indicate that a recent increase in cochlear implantation, facilitated by changes in reimbursement policies since 2017, might be associated with shifts from specialized to mainstream schooling, offering educational benefits and cost savings.