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There are two primary methods used by the For-Profit Wheelchair Industry to generate profits. They can be summarized as follows:
1. Ultra-Commoditization of the wheelchair – Fabricate a universal-fit wheelchair at the lowest possible cost. Sell huge quantities at a small profit margin. Profit is made through the high volume of sales. The wheelchair is treated like a commodity such as a metal folding chair.
2. Ultra- Customization of the wheelchair – Fabricate a one person fit wheelchair at the highest possible price. Sell at a large profit margin. Profit is made through the high profit margin. The wheelchair is analogized to a custom made prosthesis.
Is the wheelchair a universal-fit commodity or is it a custom prosthesis like device? These two perspectives are inherently incompatible.
If your goal is to sell wheelchairs to poor cash buyers without health insurance, then it makes sense to treat the wheelchair like a commodity. Since commodities are interchangeable, the seller with the lowest price gets the highest sales volume. If your goal is to sell wheelchairs to wealthy buyers or people with health insurance, then it makes sense to treat your wheelchair like a custom prosthesis and create wheelchairs with the highest profit margins.
The two profit methodologies have produced a situation where the price of wheelchairs follows the Well Curve (opposite of the Bell Curve). Many very low priced wheelchairs produced at the lowest possible fabrication cost (small profit margin), and many high priced wheelchairs produced at the highest possible profit margin, and very few in between.
Wheelchairs don’t have to be seen as either low price commodities or high price custom medical devices. That is a false dichotomy. They could also be moderately priced customizable mobility devices. But the existence of such devices calls into question the suitability of treating wheelchairs as either mass produced commodities or the need for treating all wheelchairs as highly complex/custom medical devices. In other words, this viewpoint is detrimental to the For-Profit Wheelchair Industry’s profits on both ends of the spectrum. Needless to say, it is not a popular viewpoint in the Industry.
Making money in mass production involves creating a wheelchair so inexpensively that it makes more economic sense to buy a new one than to repair it. Buyers make their decision based on low price rather than functionality, durability, serviceability, or repairability. Nobody buys a “universal-fit” mass produced wheelchair widget because they want to. They do it because they have no other choice. Manufacturers base their design not on performance, but on enabling the cheapest fabrication methods and materials.
On the other hand, making money in custom production requires producing a specialty product made of high profit margin materials and fabrication methods AND justifying the product as medically necessary in order to enable the high priced sale. As with mass production, the goal is to create products that must be repurchased rather than repaired.
It has been established that the For-Profit Wheelchair Industry makes its money by selling new wheelchairs. They claim to lose money on repairing wheelchairs. Therefore, the path to profitability is entire wheelchair replacement rather than wheelchair repair. This method is no different than what Apple has done with the iPhone. Apple is almost a three trillion dollar company. You don’t repair your iPhone; you get a new one. Planned obsolescence is a real thing.
The ultimate in wheelchair customization is the “made to measure” carbon fiber wheelchair frame. Once manufactured, the frame components (such as rear wheel position) cannot be adjusted. If one part of the frame is damaged, the entire frame will need to be replaced rather than repaired to avoid catastrophic failure. The ill-fated Titan submersible (which imploded) used carbon fiber. Some wheelchair manufacturers are expanding their carbon fiber frames to include the front casters. This means, if you damage a front caster by inadvertently slamming into an obstruction such as a curb, you may need a new wheelchair.
In order to justify the high cost of carbon fiber, the wheelchair industry must come up with reasons why its use is medically necessary. Typical justification cites the frame’s low weight which will “save your shoulders”. Simultaneously, wheelchair users are sold heavy orthopedic backrests and other accessories that add the weight right back on.
Once you understand that the goal of the For-Profit Wheelchair Industry is to produce the maximum profit possible, you can see why wheelchair design and their associated prices are the way they are. The For-Profit Wheelchair Industry methods serve their shareholders and private equity owners at the expense of wheelchair users’ wellbeing. While many industries operate in this profit seeking manner, people with disabilities are particularly vulnerable and low economic power customers. Many times, they literally have no real choice in the purchase of their wheelchair.
The real world result is millions of people across the developing world using inappropriate wheelchairs for their environment that they cannot afford to replace and are also unable to repair. There are millions of people living without a wheelchair despite desperately needing one. In wealthy countries, there are millions of people using wheelchairs that have been optimized for their profit margin potential rather than the user’s mobility, health, and welfare.
As a final note, there are many people with significant disabilities who do require extensive customization of their wheelchair. I am not referring to these situations. But just because some wheelchair users benefit from expensive customization of methods and materials doesn’t negate the systemic detriment to wheelchair users as a whole. Just like Ultra-Commoditization, Ultra-Customization is a profit maximizing strategy that benefits the few at the expense of the many.