Market for Impact

Summary

What do they do? The reviewed Hearing and Speech Center pathway provides hearing assessment and hearing aids to eligible adults. It includes fitting, batteries, rehabilitation and follow-up rather than the device alone. The pathway is described through its partnership with Project Homeless Connect. More

We include this hearing-care pathway among our top-ten research candidates because of its:

Focus on fitted, supported hearing care that can improve communication.
External randomized evidence of improvement in hearing-related health utility.
Model that accounts for clinical time, follow-up and unsuccessful offers rather than pricing donated devices alone.

Our main reservations about Hearing and Speech Center are:

The historical recipient's tax-exempt status is unresolved; a current eligible recipient must be verified before a direct gift.
The assumed cost and additional treatment capacity are not supported by a current provider quote.
Study results may not transfer to local patients, sustained hearing-aid use is uncertain, and PHC overlap must be excluded.

What do you get for your dollar?

GiveBetter considers supported hearing care a plausible way to improve everyday functioning, but does not recommend a direct gift to this recipient until its status is resolved. We assume $1,500 per offered care package: $600 for clinical labor, $250 for refurbishment and molds, $250 for support, $200 for coordination and failed offers, and $200 for overhead and contingency. These are analyst assumptions; a separate donated-device resource allowance is not included in that donor price. Source

The revised clinical benchmark is 0.11 hearing-sensitive utility from an acoustic hearing-aid meta-analysis; generic EQ5D studies show much smaller changes. We assume 50% local transfer, 80% completion, a quarter-year delay and nine months of funded benefit, adjusted separately for persistence, survival and equivalent alternative care. These local inputs are judgments, not measured HSC outcomes.

At the assumed $1,500 cost, our independently reassessed central estimate is about $151K per DALY, revised from $125K: 0.01 health years plus 0.00 income-equivalent years per offered course. We assume 10% of additional completed households gain net 2% annual resources during the funded window, with independent economic exposure. To limit generic-utility overlap, we conservatively exclude positive health credit proportionately for these earners; clinical harms remain. Keeping distinct communication and income benefits together gives $136K. These are uncertain judgments, not measured earnings or confidence bounds. More

What information has Hearing and Speech Center shared about its program?

The reviewed material describes a clinical pathway, but not current completed-course counts or local utility and earnings follow-up. Original FY2022/21/20 returns show historical whole expenses averaging $2.5M, not a current marginal fitting cost. Fresh September-cutoff IRS records still show revocation for the historical EIN, with no reinstatement date or exact Publication 78 match; a later successor or reinstatement remains unverified. More

What is GiveBetter’s qualitative assessment of Hearing and Speech Center?

There is a credible clinical mechanism and a concrete local partnership. Administrative uncertainty about who can receive a donation is separate from whether the clinic provides useful care, and does not establish misconduct or closure. We keep the research while withholding a direct-gift recommendation. More

1. What do they do?

PHC’s Core Senses page names the Center as its hearing partner and describes screening, necessary aids, batteries, support and follow-up without requiring insurance. The Center describes donated-device refurbishment. Neither page supplies a current eligible backlog, stock yield or price.

Start with an eligible willing adult

This denominator begins after clinical eligibility. Add broad outreach/screening costs if needed.

Offer assessed and fitted care

One or both ears as indicated produce one person-level outcome; failed offers remain in costs.

Support useful incremental hearing

Count use and benefit before equivalent alternative care catches up, within a finite funded window.

Scope of this review. The shared hearing ledger is phc-hsc-adult-hearing-aid-access. PHC’s separately reviewed glasses pathway is distinct; do not credit hearing QALYs twice or silently reroute a gift to PHC without confirming control and restriction. Clinical registry status is not charitable eligibility.

2. Monitoring and information sharing

Selected Singapore adults with hearing loss seeking aids; analyzed groups 264 and 163

Kaur et al., 2020 delayed-start community-centre study. Reported HUI3 utility increment 0.12 after three months.

Our assessment. Modified control questionnaire and short follow-up limit transfer. Do not import the paper’s five-year ICER, infer first-ever use from ten-year nonuse, or add dementia/mortality benefits.

66% response subset

One-year telephone follow-up. 71.4% of respondents reported use.

Our assessment. Not whole-cohort persistence and not evidence for the four-year local favorable case.

SF shared hearing pathway

PHC and provider websites. Necessary hearing care and follow-up are described.

Our assessment. Website freshness, marginal costs and actual additional slots are unresolved.

Historical EIN 94-1322198

Primary IRS bulk-data audit, revocation data labeled September 8 and Publication 78 labeled September 10, 2026. Automatic revocation effective November 15, 2025; posted March 10, 2026; reinstatement field blank. No matching entry was found in the checked IRS Publication 78 data.

Our assessment. The dataset date does not exclude a later reinstatement or successor organization. An active National Provider Identifier (NPI) does not establish tax-exempt status, current service availability or closure.

3. Qualitative assessment

Assessed, fitted and rehabilitated hearing care can improve hearing-sensitive health utility; donating a device alone is not the intervention.

Key reservations

Recipient status must be resolved before promoting a donation route; the model is clinical research, not tax advice.
Hearing-sensitive and generic utility instruments disagree; local benefit magnitude and persistence remain uncertain.
Medi-Cal, Medicare Advantage and appropriate OTC alternatives may shorten incremental access; the current adult DHCS guidance includes aid/fitting/repair coverage, but does not establish actual approvals or accessible fitting slots for this cohort.
Patient time and additional outreach are unpriced. Clinical labor is paid in the constructed budget even if currently volunteered.

Benefits not included in our estimate

No second PHC hearing credit, extra retention multiplier or per-ear multiplication.
No imported five-year lifetime ICER, dementia prevention, mortality or measured local employment gain; signed income cases are explicit judgments.
No implication that automatic revocation proves clinic closure or misconduct.

4. What do you get for your dollar?

$151K per DALY

The revised external benchmark is 0.11 hearing-sensitive HUI3 utility, with 50% local transfer, 80% completion and 50% financial additionality. A quarter-year care delay leaves nine months of funded benefit; persistence, survival and access to alternative care give 0.491 discounted clinical years. Net household resources are modeled separately. The conservative central overlap allocation excludes 10% of positive clinical credit for the income-responsive subgroup, rather than preserving the original total by subtraction.

DALY is our one-year comparison unit. QALY-based health gains and income-welfare equivalents retain their original assumptions; they are not measured clinical DALYs. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

DONOR DOLLARS per DALY: $1,500 ÷ (0.01 health years + 0.00 income-equivalent years)
$151K

Model inputs and assumptions

Complete course cash commitment: $1,500 (range: $900–$2,500). $600 paid clinical labor, $250 refurbishment/molds, $250 support, $200 coordination/failures and $200 facility/admin allowance; all constructed costs. Low / judgmental.
External utility increment: 0.11 (range: 0.01–0.14). Three-study acoustic hearing-aid HUI3 meta-analysis; EQ5D studies show a near-zero generic change. Heterogeneous instruments, not a local causal estimate. Low / judgmental.
Clinical/population transfer: 50% (range: 50–75%). Singapore selected older adults differ from SF adults experiencing homelessness. Low / judgmental.
Pre-fitting completion: 80% (range: 50–90%). Separate from later nonuse already included in effective exposure. Low / judgmental.
Discounted clinical exposure: 0.491 (range: Shorter window and faster alternative care possible). Quarter-year delay, nine months funded benefit, 85% relative persistence, 80% without equivalent care, 98% survival and 3% within-year discounting; local judgments. Low / judgmental.
Financing additionality: 50% (range: 25–75%; zero possible). Replacement funding reduces new services. Public coverage and other accessible care belong in the comparator, not automatic free-benefit claims. Low / judgmental.

Finite-horizon scenarios and explicit nulls

central: $151K. 0.01 health years + 0.00 income-equivalent years; at most one funded year
clinical and income coexist: $136K. 0.01 health years + 0.00 income-equivalent years; at most one funded year
low instrument utility: $1.3M. 0.00 health years + 0.00 income-equivalent years; at most one funded year
shorter clinical exposure: $293K. 0.00 health years + 0.00 income-equivalent years; at most one funded year
zero income: $139K. 0.01 health years + 0.00 income-equivalent years; at most one funded year
negative income: $142K. 0.01 health years + 0.00 income-equivalent years; at most one funded year
no additional funding: No finite positive price. 0.00 health years + 0.00 income-equivalent years; at most one funded year
independent harm despite no funding: No finite positive price. 0.00 health years + 0.00 income-equivalent years; at most one funded year

Uncertainty. Discounting is 3% within the year. The old 0.515 profile and four-year favorable scenario are preserved in the historical model, not used in current rankings. Current delay, persistence, unmet care and income exposure are explicit judgments, not observed adherence. The whole cash budget is committed at time zero, including support across the entire calendar window. Shared pathway harms sit inside financing additionality; independent donor health harms can persist outside it.

Health and income effects

Better communication can support work and avoid some household spending. Fitting visits, travel, missed work and lost benefits can offset those gains. A Guatemala before-and-after comparison found a small rise in median household income among recipients while comparison income fell; individual recipient income did not significantly improve. Selection, confounding and different labor markets prevent importing that contrast as a local causal wage effect.

Our provisional central income judgment assumes 10% of additional completed households gain net 2% annual resources during nine months, with an independently specified 80% economic exposure. These are small positive local priors, not measured HSC earnings or the Guatemala median contrast. Net resources include earnings offsets, taxes, withdrawn benefits and work costs. Zero and negative income cases remain plausible.

Using Coefficient Giving’s welfare comparison, income-equivalent years equal 0.5 × additional completed households × affected share × independently discounted income exposure × log(resource ratio). This is a welfare equivalence, not a clinical QALY. Clinical transfer and aid-use persistence do not reduce income again; neither clinical nor income benefit is extended beyond the funded year.

We add no device retail-value saving without evidence that the person otherwise pays for an equivalent aid. Health and household benefits from the same PHC/HSC course must be allocated once in a portfolio. HUI3 includes emotion and cognition. We therefore exclude positive clinical credit proportionately for the assumed 10% earners, assuming they have the same unmet-care distribution as other completed patients. If all earners instead belong to the unmet-care subgroup, a 12.5% exclusion is appropriate. A separate coexistence sensitivity retains communication and income benefits together. Neither allocation removes clinical harms. Funding or completion failure gives no recipient earnings from nonexistent additional fittings; independent donor harm can still remain.

Central health and income: $151K. 0.01 health QALYs + 0.00 income-equivalent years per offered course
Coexisting health and income: $136K. 0.01 health QALYs + 0.00 income-equivalent years per offered course
Zero income: $139K. 0.01 health QALYs + 0.00 income-equivalent years per offered course
Negative income: $142K. 0.01 health QALYs + 0.00 income-equivalent years per offered course
Shorter clinical exposure: $293K. 0.00 health QALYs + 0.00 income-equivalent years per offered course
No additional funding: No finite positive price. 0.00 health QALYs + 0.00 income-equivalent years per offered course

Donated devices are a separate resource input

A judgmental $600 donated-stock allowance is added to the $1,500 donor course cost for the gross-resource diagnostic. It is not an induced spending estimate, a retail device price or a net societal ICER.

CENTRAL CASH PLUS STOCK: ($1,500 + $600) ÷ combined health and income-equivalent years
$211K

QALY conversion assumptions

central: $211K. Gross resource diagnostic; patient time unknown
clinical and income coexist: $190K. Gross resource diagnostic; patient time unknown
low instrument utility: $1.9M. Gross resource diagnostic; patient time unknown

The model counts all offered-course cost before completion and funding substitution. Extending benefit beyond the funded year would require a separately costed support plan, not an unpriced lifetime assumption. No healthcare savings or unpriced extension is credited.

5. Funding and previous grants

The September 9 IRS-data review found automatic revocation for the historical EIN, with no verified reinstatement or successor recipient. This does not establish clinic closure or misconduct. Resolve the legal recipient before considering a gift; the health model alone cannot clear this warning.

IRS data list the historical EIN as automatically revoked, with no reinstatement date recorded. Later reinstatement or a successor is unverified. This does not establish clinic closure; no direct gift is recommended.

Original FY2022, FY2021 and FY2020 returns show whole expenses of $2,316,008, $2,352,018 and $2,713,993: a historical mean of $2,460,673, not a current funding shortfall or marginal course price. FY2022 audiology expense was $473,752, separate from school and speech programs. Later original accounts were not located. No current restricted package or additional fitting capacity is verified.

This review does not establish a verified marginal funding offer or a complete history of grants.

We have not verified a suitable donation route for this reviewed activity. Confirm the legal recipient and intended allocation before donating.

6. Sources

Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility. Borre et al.. Original systematic review: heterogeneous utility instruments; Kaur included, not independent replication. Published: 2022; retrieved: 2026-10-01.
Cost-utility analysis of hearing aid device for older adults in the community. Kaur et al.. Primary delayed-start study. Published: 1 December 2020; retrieved: 2026-10-01.
Core Senses partnership. PHC. Primary program disclosure. Published: Not stated; retrieved: 2026-10-01.
Donated-device pathway. Hearing and Speech Center. Provider disclosure. Published: Not stated; retrieved: 2026-10-01.
Tax-exempt bulk data and dataset dates. IRS. Primary identity data. Published: September 2026 dataset labels; retrieved: 2026-10-01.
Automatic-revocation records. IRS. Primary bulk ZIP. Published: September 2026 dataset labels; retrieved: 2026-10-01.
Publication 78. IRS. Primary bulk ZIP. Published: September 2026 dataset labels; retrieved: 2026-10-01.
Clinical NPI—not exemption. CMS. Primary registry. Published: Record updated June 8, 2026; retrieved: 2026-10-01.
Hearing-aid coverage. Medicare. Official coverage. Published: Current page; retrieved: 2026-10-01.
2024 Medi-Cal handbook. DHCS. Historical official baseline. Published: 2024; retrieved: 2026-10-01.
OTC hearing-aid boundaries. FDA. Official device guidance. Published: Current page; retrieved: 2026-10-01.
Hearing aids and livelihoods in Guatemala. Spreckley et al.. Primary nonrandomized comparison. Published: 2020; retrieved: 2026-10-01.
Cost-effectiveness and income-welfare comparison. Coefficient Giving. Primary valuation framework. Published: Current methodology; retrieved: 2026-10-01.
Adult hearing-aid benefit and covered support. DHCS. Primary coverage guidance. Published: Current official coverage; retrieved: 2026-10-01.
FY2022 original Form 990. Hearing and Speech Center / IRS. Primary return reconstruction. Published: 2022; retrieved: 2026-10-01.
FY2021 original Form 990. Hearing and Speech Center / IRS. Primary return reconstruction. Published: 2021; retrieved: 2026-10-01.
FY2020 original Form 990. Hearing and Speech Center / IRS. Primary return reconstruction. Published: 2020; retrieved: 2026-10-01.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): $2,460,673. Organization size is separate from the modeled cost-effectiveness of a donation.

Hearing and Speech Center of Northern California

Historical whole-entity Form 990 total expenses.

FY2020–2022 only: not current spending. Historical EIN's revocation and any reinstatement remain unresolved.