billbolton wrote:As amatter of interest, at what point in the supply chain is the 300% profit being made?
I doubt 300 percent
profit is the rule, but 300 percent
markup from the wholesale cost DME’s pay to the retail price charged customers/insurance companies probably is.
1) I spent a day or two last week trying to find that elusive DC-30 Adapter for my wife’s VPAP Adapt SV. I spoke to many, many ResMed “Preferred Internet Providers” trying to get a price for it. This included the predictable grumbling on my part about ResMed’s anti-competitive marketing policies. I got a lot of interesting responses from folks on the other end of the line. Long-story-short: One of them spoke of “300 percent markup” by brick-and-mortar DME’s.
2) I started out with an S8 Escape. I bought a Respironcs REMstar Auto from cpap.com for less than half of the price the DME was billing my insurance company for the S8 Escape. Figuring cpap.com probably marked up the REMstar Auto by 50-to 100-percent, 300 percent DME markup sounds about right, maybe a little conservative.
(Markup of 100% from wholesale to retail is not uncommon, and it often results in fair and reasonable retail prices. Businesses have to cover the costs of doing business.)
billbolton wrote:Its a regulated (by the FDA) ethical/medical product market, so another possible explanation is that there are structural issues in the whole market which make it effectively impossible for anyone to "take over the market".
Its not a consumer electronics market and expecting it to operate like one is not realistic.
The market for CPAP is clearly not like the consumer electronics market. The consumer electronics market is fairly competitive. The result of this competition is lots of innovation and relatively low prices.
The market for CPAP is more like the US automobile market in the 1940’s and 1950’s. There were only three real “competitors,” and GM could have driven Ford and Chrysler (not to mention American Motors, Studebaker, etc.) out of business any time they wanted but for anti-trust legislation (which was enforced in those days.)
Like the automobile market in those days, entering the CPAP market would require a tremendous amount of capital up front, and even then unseating the behemoths in a less-than-competitive market would probably be impossible. Even Henry J Kaiser could not get a foot in the door in the US auto market in the late forties/early fifties.
Innovation/competition in the US auto market took a big leap forward in the late 1970's and early 1980's when foreign competitors got a good foothold. As a result, the US manufacturers (which were ill-situated to a competitive market) are struggling today, even though their quality has improved tremendously.
There are a number of anti-competitive marketing practices in various product markets, which I would like to see outlawed. MAP is one of them.
FWIW, the FDA has
no role in regulating the
pricing of medical devices. Their role is in approving them as to safety and efficacy. Nor, in this era of Republican administrations, is there any meaningful enforcement of anti-trust law.
Wayne