CALL IT THE HOME MEDICAL EQUIPMENT INDUSTRY'S VERSION OF DAVID AND GOLIATH. AS THE INCONTINENCE BUSINESS BURGEONS THANKS TO TELEVISION AND CONSUMER MAGAZINE ADVERTISING, HME PROVIDERS FIND THEMSELVES BATTLING GIANT NATIONAL DRUG AND GROCERY STORES FOR THEIR SHARE OF THE MARKET.

IT'S A TOUGH FIGHT-AND SO FAR, THE NATIONAL CONSUMER STORES ARE WINNING.

"CHOICES PEOPLE MAKE ABOUT WHAT PRODUCTS TO PURCHASE ARE USUALLY DICTATED BY BRAND," SAYS GARY HIRSCH, PRESIDENT OF INCONTINENCE PRODUCTS MANUFACTURER, G. HIRSCH & CO. "IT IS ADVERTISING that creates brand awareness."

It is also advertising that has helped refute myths about the disorder, drawn sufferers out of their homes-and led buyers into the chain stores and away from HME businesses, some manufacturers say.

But HME providers can fight Goliath armed with more than a slingshot. Manufacturers like Kimberly-Clark, whose Depends absorbent products have become the No. 1 selling brand in the United States, according to Theta Reports, are extending a helping hand to HME providers. Kimberly-Clark has created the Kim-Care line of incontinence products especially for HME stores. A comprehensive marketing approach is bundled along with the product.

"The chains are selling national brands at low prices and margins, making it difficult for independents to compete," says Jack Evans, president of Global Media Marketing. "The move to private-label brands, like Kim-Care, allows them to sell a national-brand equivalent at a lower price and double their margin."

Creating Allure A PROVIDER'S MAIN competitive issue is how to lead the consumer away from the chain stores and into their own, says Elaine Austin, director of marketing for Humanicare International, which manufactures the Dignity line of incontinence products. "Providers need to up their advertising and work with manufacturers to bring the traffic into the store," she says. "The consumers are generally not aware there is a provider in the area unless they have been ill."

How can providers lure consumers into their stores? There are several ways, Austin says. "Consider co-op advertising, visit physicians to get more referrals, send mailings, and get involved with retirement communities," she advises. "It's just a matter of reaching out and, I believe, going to the manufacturers and saying, 'Look, I'm carrying your product. Help me.'"

Humanicare, for example, offers a Dignity kit that includes an array of support materials for the provider, as well as educational materials for the consumer, Austin says.

Once the customers are in the store, the expertise of the provider and a high level of customer service can create customer loyalty, experts say.

"Incontinence products offer HME suppliers an ideal opportunity to increase retail cash sales," says Evans. "Disposables generate retail foot traffic and repeat customers, whose impulse and add-on sales are very profitable."

The Value of Expertise ALTHOUGH NATIONAL CHAIN drug stores have seemingly cornered the incontinence market, there is plenty of room for HME providers to compete, says Evans. A provider can offer education and service, an added value that customers rarely receive in drug stores or in the mass market, he says. "You don't have to sell at the same low price as the others if your customers perceive real value in the service they receive from your staff."

HME providers can also offer the discretion and the expertise that a national chain cannot, says Austin. Those with incontinence are often embarrassed about their problem, so much so that an estimated 70 percent have yet to try an incontinence product, Evans says. Customers who avoid the chain stores for fear a neighbor will see adult diapers in their shopping cart often feel more comfortable in an HME store, experts say. "Take the time to discuss their condition, recommend a variety of samples to try and offer informative brochures from manufacturers and support groups," Evans says.

In addition to being an understanding information resource, providers can also position themselves as market leaders by stocking a wide array of products, according to experts. "The HME provider usually carries the widest variety of products, ranging from the smallest sizes to the biggest, from pads to undergarments to reusables," says Hirsch. "Once a customer has found what they can't get from the standard products [that] retail stores carry, they will return." HC

MOST INCONTINENCE PRODUCTS are marketed and designed for women, who make up 85 percent of the market, according to Theta Reports, which specializes in industry analyses. "So, where does this leave men?" asks Susan Clymer, chairwoman of Goulter Medical. "Male urinary incontinence falls into the shadow of female urinary incontinence," she says. "It is also a serious issue for them, and they need more recognition. It affects men who have had prostate surgery and men with multiple sclerosis, spinal cord injuries and large prostates."

In late 1998, Goulter Medical introduced an incontinence management device just for men. The ZIP is an externally worn, adhesive-free, single-piece collection system that rolls on likes a condom. When combined with specially designed briefs, a patient can empty it while standing at a urinal or toilet, Clymer says. "It is designed to eliminate the social and impractical constraints of absorbents and devices that rely on bag collection," Clymer says.

The device, which retails for $34.95, can be reused for up to two weeks, Clymer says. "Those with moderate to heavy leaking pay between $500 and $1,500 a year on average for absorbents," she says.

Last year, only 6 percent of those with incontinence used reusables, but that may be changing, manufacturers say. "There seems to be a resurgence of reusables, especially in underpads," says Gary Hirsch of G. Hirsch & Co. "This is mainly because of the new textiles, which are more comfortable and wash longer."

"When used as part of two-piece system with a pad, a very absorbent system is created," says Maxine Rankin, clinical product manager for Suburban Ostomy, which manufactures incontinence products. "The system will keep you safe in public even if liquid spills over the pad."

Used alone, reusables still aren't very popular, Rankin says. "More people with incontinence are active and leave their homes and changing a reusable in public just isn't convenient," she says.

* Stress incontinence represents about 30 to 40 percent of all urinary incontinence cases.

* Urge incontinence and mixed incontinence each represent 25 to 35 percent of all urinary incontinence cases among women in the United States.

* Each year, 2.5 to 3 million women visit a urologist or gynecologist for urinary incontinence.

* Incontinence affects about 10 million people in the United States at a cost of over $10 billion a year.

* Disease, side effects of medications or anatomical changes, may cause incontinence.

* An estimated 85 percent of incontinence sufferers are women.

* Diabetes affects 16 million people in the United States, 50 percent of whom are unaware of it.

* The prevalence of diabetes is rising as the U.S. population ages and as more Americans become obese.

* The estimated cost of diabetes to the nation is about $92 billion a year.

* Diabetes is the leading cause of adult blindness, end-stage kidney disease, and amputations of the foot or leg.