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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 might claim.

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.

So, the question remains, why do wheelchairs cost as much as they do? In a word, economics.

Economies of Scale
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.

Development Costs
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 cost overall.

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 realities.

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,