I like to tease that there are three subjects that I won't discuss - politics, religion, and wheelchair
costing - because no matter what I say, someone, somewhere will freak out. That is, there's no way to
succeed in discussing such seemingly "hot-button" topics.|
In reality, while politics and religion
are entirely ideological subjects, where there are no universally-recognized correct answers (except
for your own, of course!), wheelchair pricing is truly as fundamentally concrete as it gets, based not
on ideology or opinion or emotion, but on straight-forward economics. In this way, surely it's important
for consumers to have a fact-based understanding of why wheelchairs seemingly cost so much, putting any
misconceptions to rest.
A History Based on Mystery and Myth
The fact is, if you told the
average person on the street how much your wheelchair cost - say, $5,000 - he or she wouldn't have a
clue as to what that figure truly meant. Some might compare the price to other consumer goods, from lawnmowers
to bicycles, and think that wheelchair pricing is outrageously sky high. Meanwhile, others might compare
your wheelchair to other medical goods and procedures, and fathom that the price sounds about right in
context to their last hospital bill. Almost everyone, though, would agree that wheelchairs are expensive,
and no one could likely give you an educated answer as to why that is?
Of course, very few people
ever think about wheelchairs before they need one, and even most life-long users have little understanding
of how a wheelchair is developed, manufactured, or distributed, so it's no wonder that many people are
skeptical toward cost. We inherently fear the unknown - and this most certainly holds true in a consumer
setting where we fear being taken advantage of - so if someone says to Uncle Joe that a power wheelchair
costs $5,000 compared to the riding lawnmower that he just bought at Sears for $1,200, of course he's
going to think that something is up! As a result many negative reactions toward wheelchair pricing are
based around unknowns instead of facts.
In addition to mystery surrounding wheelchair pricing,
many negative views are formed strictly out of myth. I can't count how many times that I've heard someone
proclaim that wheelchairs cost as much as cars. Yet, as a whole, wheelchairs don't cost nearly as much
as cars, with the average new car in 2006 costing approximately $27,800, while the average power wheelchair
funding reimbursement for the same year was approximately $5,000 - that's a huge difference, entirely
dispelling the myth.
Still, some would say that their wheelchairs truly did cost as much as cars
- and they're right. There are most definitely disabilities and conditions - including my own - that
warrant very specialized, custom technology, where, for example, a power wheelchair with tilt, recline,
articulating power legrests, specialty seating, sip-n-puff controls, and a ventilator package, to name
a few necessary components for an advanced condition, can exceed $20,000. However, these type of ultra-high-end
medical necessities are a small part of the overall mobility market, making them more of an exception,
rather than a rule. Put simply, in general, wheelchairs don't prove as astronomically expensive as some
Therefore, when we consider the mystery and myths that have surrounded wheelchair
pricing, it becomes clear why we hear so many off-the-cuff remarks regarding the subject.
the question remains, why do wheelchairs cost as much as they do? In a word, economics.
A fundamental term in manufacturing is economies of scale, meaning that the more of an
item that you produce, the less each unit costs to produce - this is why mass-produced items are remarkably
less expensive than custom or handmade items, and why widely-used consumer goods are much less expensive
than items in niche markets.
When it comes to wheelchairs, individual models typically operate
in very limited economies of scale. The fact is, there's far less demand for wheelchairs than for most
other consumer goods, and many wheelchairs are custom-built. These realities simply make wheelchairs
notably more costly to produce than other products.
To elaborate on this concept, think for a
moment about the families who live within a 2-mile radius of you. The chances are that every house has
a television and a car - and sometimes several of each. Now, how many do you suppose have a wheelchair?
Of course, the answer is very few to none. Wheelchairs simply aren't as common as most consumer goods,
dramatically reducing overall volume efficiencies. With such scarcity, there's no way for wheelchairs
to compete on the volume scale of televisions or cars, which makes wheelchairs more expensive to produce
even at the most fundamental level.
What's more, the cost of manufacturing increases even more
when you consider that many manual and power wheelchairs are built to order. For many of us with complex
disabilities, our wheelchairs must be matched to our individual needs to best suit our health conditions,
and as a result require very tailored products, built one at a time, to our exact specifications. You
may recall looking at a wheelchair order form and seeing over 100 item choices. These choices aren't
out of want for most, but out of necessity, where if a manufacturer doesn't offer even the most obscure
of component, it may prevent an entire wheelchair from meeting one's need for mobility. Therefore, as
a class of products, wheelchairs are inherently far more custom than most.
As users, we can sometimes
become very focused in our views, presuming that every user has our exact mobility needs, that wheelchairs
should be able to be mass-produced in small, medium, and large. However, that's simply not the case,
where many of our wheelchairs are custom built to serve our individual medical needs. I mean, if you
think about it, have you ever met another person with the exact same wheelchair as yours, right down
to the same seat size, legrests, and color, to name a few specifications among 100 hundred or more? Indeed,
it's in this no-two-wheelchairs-are-alike realm that manufacturing costs become very expensive based
on specialized components in limited quantities that are labor-intensive to build.
For these reasons
of dramatically reduced volumes, and complex manufacturing processes, wheelchairs truly function under
a different economic scale than many other products.
In addition to complex
manufacturing economics, wheelchairs also increase in cost due to stringent regulatory and development
processes. I've read users on Internet message boards state how poorly engineered and built wheelchairs
are, that they could do it better out of Tinker Toys (and, my favorite citing was a user who seemingly
sincerely stated that he didn't see the difference between his $7,000 power wheelchair, and his daughter's
$150 electric Barbie Jeep riding toy). However, quality mobility products by responsible manufacturers
go through extraordinary development and testing, to a far greater extent than many people realize.
An example that I like to use of how intensive wheelchair development is, is by describing the process
of developing the most simple component on any wheelchair: The push handle grip.
When I note a
push handle grip, I literally mean just the grip - that is, the rubber hand grip that's placed on the
back canes' push handles. To properly implement a push handle grip as a component on a wheelchair, it
must be designed of appropriate dimensions and texture, made of hypoallergenic materials, and verified
as flame retardant. Next, the grip has to undergo specific tests to ensure that it cannot be inadvertently
pulled off of the wheelchair, undergoing oven, freezer, and pull tests to make sure that no matter in
Alaska or Arizona, the grip will retain its safe form, fit, and function in all uses. All of this must
be intricately documented, as well, to comply with medical device regulations set by the government.
Certainly, Uncle Joe would say that such testing of a "bicycle handlebar grip" is ridiculous. However,
it's not ridiculous when considering the event of someone assisting an end user down a curb, where it
could be a very dangerous situation if the hand grip slipped off.
A hand grip is just one simple
example of the development time - and, ultimately, costs - that go into the development of a wheelchair,
where the development of an entire power wheelchair, for example, is an extraordinarily involved process,
truly on the level of other medical devices regulated by the FDA.
As such, high-quality, responsibly-manufactured
wheelchairs undergo a development process and investment that can be much greater than other consumer
goods, where that cost has to be distributed into the final product, contributing to the final wheelchair
Beyond manufacturing costs, supply chain economics come into play,
as well. Wheelchairs are unique from many other consumer goods in that they require sale and service
obligations by notably trained personnel well in excess of other goods.
A proper rehab wheelchair
purchase involves a clinical assessment, a demonstration period, a documentation process, an ordering
process, an insurance funding submission process, a fitting process, and a follow-up process, all of
which takes a lot of time from skilled mobility professionals. If done right, it wouldn't be extraordinary
for a provider to invest a total of 30 to 40 hours in personnel time throughout this process - that's
an intensive investment for the sale of one rehab wheelchair. So, going back to pick on poor Uncle Joe,
while it may have seemed to him that his provider simply had him sign on the dotted line for his new
power wheelchair, and then the provider ran to collect the cash, the reality is that professional providers
have to invest significant amounts of capital in merely running their businesses in a way that's most
ethical, professional, and conducive to consumers, all of which adds to the final cost of wheelchairs.
Curbing Crooks and Cheats
In understanding wheelchair costing, one should wonder, does an earnest
economics explanation cover all individual situations and pricing?
Of course not. The fact is,
there are exploitations in every industry by unethical, unscrupulous people, including in the wheelchair
industry. Sure, we've all seen sub-standard products and components billed and sold at outrageous prices,
with no service whatsoever. However, such disheartening - sometimes illegal - actions don't reflect the
legitimate design, manufacturing, and distribution channels that deliver quality products based on economic
Raising the Curtain on Wheelchair Costing
As emotional as people become over
wheelchairs - and, no one truly wants to have to use one, let alone absorb such financial costs - wheelchair
costing truly comes down to economics, where they are low-volume, highly-tailored, regulated medical
devices that are distributed through a necessarily labor-intensive supply chain.
When one puts
mystery, myths, and misconceptions aside, and takes time to look at the true economics of responsibly
manufactured and distributed wheelchairs, it's evident that there truly are economic reasons why wheelchairs
cost notably more than other goods.
No, no one wants to pay such a high price for an item of
necessity, but I trust that you'll agree that when our wheelchairs are properly manufactured, fitted,
and maintain, they become more about liberation and less about cost.
Published 2/08, Copyright 2008, WheelchairJunkie.com