1.4% of India’s 1.4 billion population is movement disabled. A study that examines the prevalence of disability across income classes found that all kinds of disabilities were more concentrated among the poorest category whereas the richest wealth quintile showed low prevalence.
The Indian population continues to be vastly underserved, the delivery of treatments is extremely skewed with a lack of tertiary care and supply of quality medical treatment. In specific, arm amputees in the country encounter numerous barriers to have access and purchase good prosthetics. Tariffs make components of prostheses expensive and the lack of concrete regulatory framework discourages companies from breaking into the industry. Nearly all of the top 40 companies in the medical device sector dominate the market for medium to high- end technology.
Cost versus Convenience
Amputees do not have enough options to select from, and the most common prostheses in the market are not comfortable; neither are they customizable nor are they efficient to complete daily tasks. Therapy services offered to amputees are dismal; users rely on private commercial services that are often expensive and only focus on short-term rehabilitation goals.
In a study conducted by Oxford University among prosthetic users in India, the main reasons cited for not wearing their prosthesis were that the device was heavy, and the harness and socket were uncomfortable. It concludes that prostheses available in the market fail to ensure users regain previous levels of occupation and improve functionality. Another study that analyses literature over 25 years concludes that the most common complaints about body-driven hands are the slowness of movement, difficulty in maintenance, the heaviness of prosthetic, insufficient grip strength, and high-energy expenditure to operate. Around 57% of the population earns below ₹ 2.5 lakh (roughly $3410), and only 35% of the population earns between ₹ 2.5- 10 lakh ( roughly $3410-$13640). Amputees that fall in these income brackets constitute 92% of the population cannot afford high-end prosthetic arms that cost between ₹ 35-40 lakh(roughly $47,600 -$54,400). Most of them are unaware and cannot afford effective therapy at private clinics.
In other words, a vast majority of amputees are unable to afford to pick up a mug of coffee, turn a knob or put on a coat.
The price of normalcy is too expensive for the majority of Indian amputees.
The prosthetics market has a gaping hole. As is typical for an industry dominated by a few giants, like ‘Ottobock’ and ‘Zimmer’, new companies find it difficult to enter the market. What makes it especially challenging is the structure of distribution channels. Doctors typically suggest well -known brands to amputees, and they purchase appropriately priced prosthetics from well- established clinics, prosthetists and trauma care centres. Patients trust their doctors with these decisions, and doctors trust old and well-established brands with their patients. Additionally, government rehabilitation programs are ineffective, and NGO-provided aid cannot cover the entire population. Therefore, there isn’t an expansive selection of financing options for expensive prostheses.
Much Needed Disruptive Technology
However, there are new companies challenging the norm in the industry. Various biomedical- start-ups, for example, provide efficient prostheses and affordable prices. 3D printing is starting to emerge as a viable production method, and financial schemes recently established by the government would ensure higher ease of doing business in this industry.
Companies like Symbionic too strive to make a difference in this area. In terms of product design, traditionally-made prosthetics may take weeks or months to produce. 3D technology allows Symbionic to cut down manufacturing time to a mere 3-5 days. This technology also allows for a greater degree of movement and control that factory-made prosthetics don’t have, and allows for customization of fit.
In terms of therapy services, Symbionic aims to set up VR-therapy units in hospitals to offer a cheaper, yet more effective alternative to current therapeutic practices in trauma care centers. A study in 2018 concludes that VR has become a very important option for effective pain management. As VR system cost has fallen in recent years, immersive VR is increasingly used as an adjunct therapy and may soon allow for patient-directed analgesia in the outpatient setting. It also acknowledges that there is potential for greater research into identifying long term treatment of pain.
Poor access to high quality prosthetics, expensive price ranges and lack of affordable therapy services lead to poor quality of life. These problems lie in regulatory and economic barriers created by virtue of the nature of the industry.
While the question of ethics is highly debatable, it is clear that the problems that arise because of the industry structure create unjustifiable barriers for amputees to lead a normal life. It is highly important to amputees, and to the larger population, that such devices are made affordable and accessible, and that new structural changes are made for start-ups to enter the industry.
Sruti is currently an intern at Symbionic and a third-year student at Emory. She’s an Economics major and hopes to pursue research in the field of developmental Economics in the future.
“Persons with Disabilities” . Ministry of Statistics and Programme Implementation. November 2019.
Hifz, Rahman. “Socio-economic inequality in the occurrence of disability in India: Evidence from a large scale sample survey.” International Institute for Population Sciences.
“India Medical Devices Report Q3”. BMI Espicom, Deloitte analysis. 2014
Medical Devices Making in India -A Leap for Indian Healthcare.” 2016. https://www2.deloitte.com/content/dam/Deloitte/in/Documents/life-sciences-health-care/in-lshc-medical-devices-making-in-india-noexp.pdf.
Nagaraja, Vikranth Harthikote et al. “Examining the Needs of Affordable Upper Limb Prosthetic Users in India: A Questionnaire-based Survey”. Technology and Disability, vol 28, 1 Jan, 2016, 101 – 110. Accessed August 7, 2020, https://content.iospress.com/articles/technology-and-disability/tad448
Bidiss, Elaine, and Tom Chau. 2007. Review of Upper Limb Prosthesis Use and Abandonment: A Survey of the Last 25 Years. Sage Publishing. September 1, 2007. https://journals-sagepub-com.proxy.library.emory.edu/doi/full/10.1080/03093640600994581
“Income Tax Payers Data: People Earning Less than 2.5 Lakh Constitute 57% of Taxpayers: Govt Data: India Business News – Times of India.” The Times of India. TOI, August 13, 2020. https://timesofindia.indiatimes.com/business/india-business/people-earning-less-than-2-5-lakh-constitute-57-of-taxpayers-govt-data/articleshow/77519141.cms
Pourmand A, Davis S, Marchak A, Whiteside T, Sikka N. ” Reality as a Clinical Tool for Pain Management.” Curr Pain Headache Re (2018). (accessed August 11, 2020).