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The Legacy Wheelchair Industry has successfully convinced much of society that their pricing structure is simply the reality of the economics of Economy of Scale. In other words, the high cost of (high end) wheelchairs is a fair reflection of what is actually costs to produce them (since they don't make that many), plus a reasonable profit margin. Nothing to see here, people!
In a healthy industry, forward thinking companies are constantly looking for innovative ways to manufacture their products more cost efficiently in order to gain a price advantage on their competition. On the other hand, the Legacy Wheelchair Industry's innovations always seem to increase production costs by incorporating exotic materials such as carbon fiber and using exacting “made-to-measure” bespoke processes (ultra-customization).
As long as their captive audience (wheelchair users and insurance companies) continue to pay these ever increasing costs, manufacturers have no incentive to change their practices. They have no reason to research and develop more efficient and lower cost methods of production to lower prices which would then enable more people to access the wheelchairs they need.
The problem is NOT the existence of expensive custom wheelchairs. The problem is a lack of affordable alternatives for those unable to acquire high priced wheelchairs.
We have all heard the story of the frog in the boiling pot. Many wheelchair users have been boiled by the Legacy Wheelchair Industry for so long that they think being scalded is the normal state of being. When confronted with the idea that they have been victimized by monopolistic pricing practices and persuasive marketing campaigns, some tend to reject it. They have become unwitting disciples of the industry’s talking points and efforts to maintain the status quo.
In the 1990’s, there were small and innovative wheelchair companies that were producing affordable manual wheelchairs. These companies are now gone. Many were bought out by larger wheelchair companies which were then taken over by Private Equity. The advent of Medicare’s K0005 (ultra-light wheelchair) designation put a floor on prices. Hence, there was no point in selling a wheelchair for a price point less than what Medicare would reimburse. With the price floor set at a high level, the Legacy Wheelchair Industry with its large marketing budget and industry connections to rehabilitation hospitals have come to dominate the wheelchair market.
Innovation in wheelchair development has become about finding new ways to add high profit components to the wheelchair which drive up its price and the subsequent profit margins from selling the entire wheelchair package. The process of ultra-customization of wheelchairs is used to justify expensive manufacturing methods and materials.
It is important to keep in mind that many wheelchair users with private health insurance still have a co-pay when obtaining medical equipment. A 30% co-pay on a $10,000 wheelchair costs the individual $3,000. Despite the high cost of wheelchairs, many wheelchair users still end up with an ill-fitting (but expensive) custom wheelchair. Rather than use this wheelchair for the next five years, some resort to paying cash in the Secondary Market for another expensive (but hopefully better fitting) wheelchair.
Wheelchair users suffer from a collective action problem where each individual doesn’t think they have the power to make a difference. This situation is made worse by those who believe and perpetuate the Legacy Wheelchair Industry line that high wheelchair prices are the natural result of the economics of Economy of Scale - “Yes. wheelchairs are expensive, but it can’t be helped. We/they have to make them this way for you. Otherwise, they will be low quality.” Such an argument is likely to be made by a sales representative or a wheelchair user who already purchased an expensive bespoke wheelchair.
In the United States, manual wheelchair prices can vary from $100 to $10,000 or more. That means an expensive wheelchair costs 100 times more than a cheap one (or that the cost of a cheap wheelchair is 1% of the cost of an expensive one). Manufacturing cost is not an either or proposition (either very cheap or very expensive). There is also a middle ground. Some (but not all) of the methods of mass production can also be applied to high function wheelchair components for reducing costs without sacrificing quality.
When you sell a luxury $10,000 wheelchair, you can’t also sell an equality functional (economical and less profitable) wheelchair for $2,000 because it calls into question the value of your $10,000 model. Therefore, you only make and sell expensive wheelchairs and claim that this is the only way it can be done. And you don’t want anyone else to either! Therefore, you do your best to quash the affordable end of the market.
You convince everyone that a less expensive (affordable) wheelchair is inherently low quality or low performing (junk) in some manner, like a $100 wheelchair actually is. Therefore, any upstart company that tries to enter the market by selling affordable and functional wheelchairs is immediately suspect and unable to gain market traction.
Conversely, if people are already buying your cheap, yet low function, mass produced hospital wheelchair for $100ish, then you have no incentive to make a higher functioning one and sell it for a little bit more - regardless of the improvement in mobility and quality of life it would provide for buyers. In this case, innovations mean driving down manufacturing methods and costs to super cheap with no regard for quality.
All of the above result the current wheelchair market dichotomy. Cheap wheelchairs remain low cost and low functioning and exist in much of the word. High cost and high functioning wheelchairs keep getting more expensive to obtain and repair. And the functional, affordable and repairable end of the wheelchair market remains undeveloped by design.
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