Tough, difficult to break into, impossible to penetrate: If there's one thing industry leaders agree on, it's that the market for manual wheelchairs is anything but a carnival cakewalk.

Overseas competition, reimbursement struggles and the fight for market position amount to a volatile industry, according to experts.

Mike Serhan, vice president of sales and marketing for Dr. K International, says from his perspective as a new West Coast manufacturer, a primary challenge is raising dealer awareness of new manufacturers in the marketplace. “I consider myself one of the 1,000 angry Chihuahuas trying to break into this market,” Serhan says. “Ultimately, the dealer is going to have better prices and better products because they don't have to go to the 800-pound gorillas [for products] any longer.”

Other industry professionals agree. “Sunrise and Invacare own the market,” says Bob Crabtree, national sales manager for Nova Ortho-Med. “It's not about price or product quality. People fall into the trap of going to the products they know, and therapists know Sunrise and Invacare.”

According to Jim Black, marketing analyst for Sunrise Medical, what puts Sunrise and Invacare ahead in the market is their ability to focus and educate. “We are a resource for therapists, and they use us in that capacity.” Coverage is the key, Black says. “We have a lot of reps covering a lot of regions and areas,” he says. “It's more difficult for a smaller company with representatives covering half the country to focus on particular hospitals or rehab agencies.” It's the responsibility of the manufacturers, Black says, “to educate both dealers and end users about what's truly available to them.”

Dealers and therapists need to spend time with new companies to educate themselves, because competition in the market is “better for the dealer in the end,” Serhan says. “We don't go after those unhealthy, bottom-feeder dealers only concerned with money who want the inexpensive, no-bells, no-whistles chair,” he says. Instead, Dr. K seeks out dealers who care about the long-term costs, and “people who want to help people.”

Manufacturers need to educate dealers about why it's better for the health of the end-user, “to teach dealers to do the right thing,” Serhan says. But this game plan doesn't come without expense. “You can't just send out a fax flier to convince patients of quality and innovation,” he says.

The appearance of several new players in the manual wheelchair market has caused a drastic decline in dollar value for manual wheelchairs over the last six months, according to Crabtree. “The same number of chairs are selling for 10 percent less,” he says.

Overseas competition — although not a new phenomenon in the market — also is a factor in this profit decline. “Even the large manufacturers — the big boys — are importing chairs,” says Crabtree, who insists that this has been a trend for the last three or four years, since Graham-Field's Mustang chair, which was manufactured in China.

“You're seeing a lot of cut costs [domestically], which will impact quality, along with movement overseas to cut costs,” says Sara Oxton, market manager for rehab products at Otto Bock. She includes South America, Latin America and Asia in the category of overseas competition.

Other experts agree that overseas competition is bringing down the national market for manual wheelchairs. American-made manual wheelchairs are having difficulty competing with overseas chairs, “because overseas products can be bought for probably half the price for what it costs us to build it in the United States,” relates Helen Lee, customer service manager for Theradyne.

“Too many people are going overseas to have chairs copied for less cost,” Serhan adds. “If it looks like a chair and costs $99, that dealer is going to save $35, but will ultimately lose that money saved to later repairs.” According to Serhan, dealers that fall into the import trap are “turning a blind eye to their patients.”

Price Erosion

According to Oxton, the market for manual wheelchairs is experiencing 8 to 9 percent growth a year. “And that's good growth,” she says. “But if you look at the number of people in chairs next to the revenue [generated by those chairs], what you see is price erosion, a disconnect. To me, it's not a healthy, strong market.”

Black also recognizes the downward price erosion in the general manual wheelchair market that Oxton cites. “On the industry growth side, it's around a 10 percent range,” he says. According to Black, much of the reason for the slow pace is new technology in the market. “In our industry, we're a little behind the times in technology,” he says. “In the last five years there haven't been a lot of big changes to the manual wheelchair market.”

Within the next year, however, Black and others predict new technologies and innovations will hit the market. Foster Davis, national sales manager for Freedom Designs, says these innovations are coming about because of a “hands-on” approach on the part of manufacturers to address patient needs. “We're going into clinics to identify needs,” he says. “We are looking at what moms need, what dealers need, and what therapists need?”

According to Oxton, innovations in the market are being driven by user demand. And what end-users are demanding is a lighter-weight, more-adjustable, contoured manual wheelchair, according to experts. “‘Lighter-weight’ is the buzz word this year,” Black says. Lightweight materials are the major innovation boosting the market, and are “the key to a healthier way of living in your chair,” he says. Magnesium, for example, takes 20-30 percent of chair weight away, “making it more efficient and more effective to push or be pushed in your chair,” according to Black.

Positioning also is in demand. Modular headrests no longer are just a place to “rest,” or lie back on, according to Oxton. Innovations in cushions and accessories that go on the manual wheelchair have been elevated to a position of importance, she says, so that “headrest” might now be an outdated term. Black says positioning is geared toward more contoured materials, which are “designed to relax your body and make you more comfortable throughout the day.”

Manual wheelchairs, especially those in the pediatric lines, also are moving toward a more adjustable frame, according to Davis. Manufacturers are trying to “forecast the growth of the child in height and skill,” he says. Newer manual chairs typically start with front-wheel drive and as children start to understand movement, the wheels are brought back like a more conventional chair, Davis explains. The convenience is in having a single chair make the transition along with the child, rather than requiring the purchase of additional chairs.

That Familiar Roadblock

No matter what patients want or need, reimbursement still can present a stumbling block for everyone involved in the market. Serhan calls it “a headache industry,” and says that reimbursement slows down the money flow.

These patients have invested in a product that's essentially “their home, their car and their legs, and sometimes it's the wrong product because of third-party pay problems,” Serhan says.

Industry leaders agree that the solution is to educate funding agencies and work with the system to establish clear, functional guidelines for smooth reimbursement transactions. Manufacturers need to educate funding agencies about the importance of these chairs for the patients' quality of life, according to Black.

Will small, new companies be able to compete in the manual wheelchair market, keeping up with what Serhan calls “the 800-pound gorillas” on reimbursement paperwork and patient demands? Although Serhan and others are confident they will, a few industry leaders have their doubts. “I think we're going to see the same thing as in the airline industry,” Lee says. “There are going to be a few [companies] that will stabilize and run it.”

Experts Interviewed

Jim Black, marketing analyst, Sunrise Medical, Longmont, Colo.; Bob Crabtree, national sales manager, Nova Ortho-Med, Gardena, Calif.; Foster Davis, national sales manager, Freedom Designs, Simi Valley, Calif.; Helen Lee, customer service manager, Theradyne, Jordan, Minn.; Sara Oxton, market manager for rehab products, Otto Bock Health Care, Minneapolis; Mike Serhan, vice president of sales and marketing, Dr. K. International, Monrovia, Calif.