Prosthetic arms, hands and hooks and other orthopedic technical products. Swiss Disability Insurance. Swiss import regulations.

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Currently, orthopedic products for upper extremity amputees – prosthetic hands, hooks, cables, replacement parts, liners, silicone liners, cosmetic gloves and so on – as well as other stump wear such as stump socks are imported to Switzerland and re-sold through solitary exclusive corporate channels or company conglomerates.

People are often interested in how, exactly, prosthetic arms are evaluated and paid for in Switzerland. I mean, how, *exactly*. Particularly now, as there are an increasing choice of so-called “bionic” and sport supporting systems out, one might wonder what Swiss athletes, managers and other people actually do should they need a prosthetic item that is somewhat out of their reach or that they would like to see covered by insurance. As that is not being discussed in public, though, it is a matter of public interest to discuss import regulations.

If ever one tries to do a direct import to Switzerland, the usual answer of the company representative is for me to buy it through a Swiss orthopedic technician. That is where the product is sold at absolutely prime prices if at all the technician manages to fight through an English catalog. With not an inch better quality.

Turns out that forcing me to do that is illegal in Switzerland. Turns out that I (as customer) or my technician (as the one that buys the stuff) are perfectly entitled to directly import to Switzerland ourselves – and if you as manufacturer abroad believe you can coerce us to feed some of your friends by having them add howevermuch to that price you are selling it locally, you do infringe on Swiss law. Nikon tried to suppress direct import and was fined with 5 million CHF recently.

Still, as consumer and customer, it is currently almost impossible to buy orthopedic products – prosthetic parts, stump socks – anywhere else than at the orthopedic technicians’ offices. Orthopedic technicians are always named as the one institution where I – as amputee – would be – in the view of manufacturers – entitled to buy.

Our state disability insurance / Invalidenversicherung (IV) restricts support to simple and effective technical means for work. All items for comfort, sports and play have to be paid for myself. The list contains stump socks, sports equipment, choices of hooks and other parts.

Along the trade and import relay stations, prosthetic and orthopedic products get a massive increase in price. That increase is paid for by (a) disabled consumers such as me or (b) insurances such as disability insurance / IV – Invalidenversicherung. Mostly, the ones that get screwed by this type of scam are insurances – so really, tax payers and insurance members are getting screwed. Because it is a scam. Import into Switzerland is not subject to any particular regulation or quality control. Prosthetic or orthopedic items such as prosthetic hands are absolutely equal to t-shirts, socks, shoes or trousers. In other words, current resale channels are enforce at the loss of the user, and without any increase in product quality.

In fact, a lot of prosthetic components are manufactured in a particularly cheap fashion. The discrepancy between miserable product quality and high price is huge. The assumption that in fact, orthopedic medical import companies are dealing with body parts, is not matched by trade law. There, they are dealing with items that legally are indistinguishable from cheap junk. Always instructive to check out photos of my cosmetic hand that is built with cheap wire and cheap mounting foam.

As dependency of amputees and insurance situations are exploited, these companies are actual social parasites: they ream off, and they do so sometimes even illegally, and consciously.

Swiss price surveillance office is not interested in the subject too much. However they point to the orthopedic support section of the disability insurance. There, at the Federal office of Social Insurances (Bundesamt fuer Sozialversicherungen BSV), I obtain confirmation that orthopedic and prosthetic products such as the ones mentioned above are not at all restricted, regulated or particularly inspected, controlled, checked or otherwise legally constrained. They are, in each and every aspect, similar to all kinds of consumer products such as shoes, socks or shirts.

And that means that (definitely since August 2009), companies must not restrict parallel imports to Switzerland. In other words, if Ossur (Sweden) does not sell to me directly (but to other customers in Switzerland), but restricts me to a Swiss or German reseller, they thereby restrict my right to conduct a parallel import. That, in Switzerland, is not allowed.

http://www.videoportal.sf.tv/video?id=0fc13161-b4eb-4ac8-a7c7-621974ccab1a;did=d-a57e717f-6566-471e-bab4-53012efb2e3e

As you can conclude from this (German) TV sequence, Swiss cartel commission (WeKo) invites submissions of problematic situations. They already fined Nikon with 5 Million CHF (currently about 6 Million US) for trying to block someone to do parallel imports to Switzerland. You could now very well assume that I will be more than happy to wait for someone to redirect me to my orthopedic technician, so I can then submit your company to that cartel commission and get you fined – but I could not possibly comment.

[German > English translation of the remaining text is currently in progress] [but as long as you allow me and everyone else to directly order from you, rather than blocking us and rechanneling us to your expensive Swiss importer, you are doing the right thing]

There are some relevant detailed comments to be made here.

1) Parallel importing

Parallel import means the following: a company that manufactures prosthetic gloves in China and has their office in Hong Kong regularly sells their gloves through Ortho Reha Neuhof (Germany). That would be where my orthopedic technician orders these gloves for considerable prices. – If I, privately, would order such a glove directly in Hong Kong, that then would constitute a parallel import.

Obviously there is a lot of money to be made in re-selling goods. Thus, many companies and their affiliates try to suppress parallel imports any way possible. Since August 2009, Swiss trade and cartel law forbids the suppression of parallel imports. And our cartel commission means it – they even fined Nikon with 6 Million USD recently.

A company representative of Medi GmbH (Germany) told me very clearly that I (living in Switzerland) would not be able to order their product (an Umbrellan stump sock) directly. She said that quite clearly I would have to buy it at my orthopedic technician’s shop, who would order it through Atlas Medical (Volketswil, Switzerland). Stump socks underlie no regulation at all, in Switzerland these are goods just as socks or shirts. Forcing me to order elsewhere makes the act of that company representative legally objectionable in Switzerland. In other words, this is not legal.

A person working at Strack AG (Schaffhausen) tells me I can only order Otto Bock (Germany) stump socks through my orthopedic technician. Both Otto Bock and Strack, if cooperating in this, act illegally.

Prosthetic manufacturer TRS Inc., USA told me after I had asked for an Adult Grip Prehensor to turn to Centri (Schweden) who then forwarded me to Frey Orthopaedie-Bedarf AG in Switzerland. There, the Adult Grip Prehensor that should not cost more than 500 CHF is sold for about 2500 CHF. Buying it at my orthopedic technician’s who adds about 30%, the price will then be around 3300 CHF. That price difference shows that some people are clinically insane: no normal amputee will pay 3300 CHF to feed that type of highway robbery – first of all because of pride. Secondly, no quality is added. The product neither gets better, faster, sturdier, lighter or covered with better warranty. Thirdly, also prosthetic components are not regulated in Switzerland. They underlie the exact same regulations just as fans, cables, wires, shoes or ties. It is forbidden to deny me, as Swiss customer, a direct import option. They try it – but it is not legal to do that.

2) Prices and quality

Otto Bock prints “CE” onto their Movohook 2Grip. This is there to suggest the Movohook 2Grip would actually be CE conformant. In other words they pretend their product conforms to some quality guidelines. From practical usage I can assert that this product has deep issues. The official Otto Bock product declaration states that the hook is built to function “service free”. Bollocks. The hook has a cheap plastic disc inside. That wears down real fast, a few months and the hook exhibits an extreme wiggle of about 5mm or more. Then it must be serviced. Another problem of that hook contains the springs and the lever – at one point, wear down can cause the hook claws to not fully close any more.

Funnily enough, the prosthetic component specialists of the BSV (Federal Office of Social Insurances) is entirely aware of the issue. She also said that the “CE” label was a self declaration thing and as such, it was useless. She said that the BSV or disability insurance (IV) has no restrictions on where to buy prosthetic components. As far s insurance is concerned, the products can be purchased anywhere. She said they were more concerned that the parts bought and combined actually were technically compatible but she said also, that was a given.

It is pretended – by orthopedic technicians or manufacturers, resellers or importers – that the BSV or disability insurance (IV) only accepts orders from such expensive resellers. A fact check with the people in charge reveals otherwise.

My orthopedic technician also sold me Otto Bock adapter pieces for 80 CHF each that are so cheaply made, that a number of them actually failed. The variance of their diameters was too large. As rumors have it, Otto Bock lets them be manufactured in China, and does not conduct their own quality control. Rumors, you now they can be true. From close up inspection we figured these Otto Bock “surprise diameter” bolts cost no more than about 2-3 CHF to manufacture. While Otto Bock never quite managed to simply apologize for their audacity they support sadomasochistic amputee fetish art instead – goes to show what brains these folks have. Here, however, these bolt problems illustrate how jacked up trade inflated prices do not at all improve life for the end consumer. Instead, my huge payment of 80 CHF for what boils down as a 1 dollar crap item is, at least in part, used by the oppressors of Otto Bock to finance psychopathological attitudes that are directly hostile and degrading to amputees. And that is where problems start to become house sized. That is why friends don’t let friends wear Otto Bock.

Quality of a Regal Prosthesis glove is the exact same whether I order it through Hong Kong or Ortho-Reha Neuhof (Germany). It is just more expensive at the Neuhof place. In Switzerland (and I hope you do sense a pattern here) it is forbiddden for both companies to restrict my orders to just about any of these – I am absolutely entitled to directly import from Regal Prosthesis in Hong Kong – even if they hate it. They otherwise infringe on Swiss trade law and – as example show – can be fined quite heavily.

In addition, by and large and overall, quality of most prosthetic components and orthopedic products is so bad that its contrast to high prices and absolutely laughable arrogance of the customer representatives is blinding.

3) Biased information to customers

Swiss orthopedic technicians usually sell any part they order in and process or just hand on to me with an added sales fee of +20% to +30%. For a 45’000 CHF iLimb, their commission is therefore 15’000 CHF just for handling the parcel. Just in case you wondered. And just in case you wondered why Swiss cartel law now explicitly allows parallel imports.

No one understands why but through sorcery and magic, prosthetic parts for myoelectric arms are about 5-10 times as expensive as prosthetic parts for body powered arms. So quite naturally, Swiss orthopedic technicians want to sell myoelectric arms. If you have followed my explanations so far the reason to that should be rather obvious to you.

A myoelectric arm usually features parts that – alone, without works and socket – may amount to 30’000 to 50’000 CHF. That makes the sales overhead that my prosthetic technician can take in 9’000 to 15’000 CHF without even bending as much as a little finger. Conversely, body powered arm parts may amount to just about 3’000 CHF and that leaves the technician with mere 900 CHF handling fee – nothing compared to the other sums.

The problem though is that customers that get used to body powered arms – to good and well made body powered arms, that is – have a hard time to move to myoelectric arms. That means that it is best to sell everyone myoelectric arms right from the very beginning. That is really what they are doing. They advise arm amputees to start off using Otto Bock myo arms – quite simply because these generate most income for themselves. However, they also have the role of prescribing and a role as advisor, they are publically paid through social insurance.

If ever someone asks for a body powered arm, it will be built in such a fashion that the experience will be negative. It is a lot of work to drag these people out of that attitude and go full format with body powered arms. Once they forget their money making schemes some orthopoedic technicians actually can offer useful advice, I found. But it usually takes them some time.

However, the average advice you will get about prosthetic arms will be extremely biased – at least, if you ask a Swiss prosthetic technician.

4) Quality control for body powered arms

It is a rather difficult question one is confronted with. Is one’s own body powered arm built right? Or has an orthopedic technician tried to provide sloppy works to convince you that myoelectric arms are “better”?

Often, orthopedic technicians should provide crucial serivces for the amputee – but neither are they really networked well, nor are they informed well. They sorely lack product oversight and technical skills. It is not an accident that that particular industry’s failure rate – over 50% of upper extremity amputees reject prostheses – is extremely high. If however orthopedic technicians knew that they could sell parts – any parts – directly to Switzerland (and if they manage to be a tad less greedy than the import channel company representatives) they could indeed make good money on the side. If Swiss orthopedic technicians would buy cheap directly at the manufacturer rather than buying it at the importers’ rates, the difference to what insurance pays could be considerably larger. It is generally not advisable to ignore such suggestions as an orthopedic technician – neither with regard to technical issues nor with regard to trade issues.

It is a fact that orthopedic technicians cannot just build body powered arms. Building legs, building myoelectric arms, are quite unlike body powered arms. Even orthopedic providers with a great track record of doing prosthetic legs and arms often if not routinely lack know-how, experience and ability to provide body powered arms. As body powered arms can be comfortable, extremely robust, useful and light, affordable and reliable – if built right, that is – not having the ability to build good body powered arms is a handicap, both for the orthopedic technician and the amputee.

So many orthopedic technicians are unable to build body powered arms properly and well. However, even though they cannot provide these, they often use that as advantage to discourage amputees to wear these. With one or two cumbersome harnesses and smelly harness covers, a few damaged cables and any client will want to leave that type of tragedy behind. Then, costly myoelectric arms appear like a solution to the client while it actually is a solution for the orthopedic technician.

Orthopedic technicians – at least the ones in the USA – also pay rather substantial sums for professional lobbyism. They ambitiously work towards influencing the system to their own advantage. That may – or may not – be the interest of the clients. A country such as the USA with a huge difference between desire and reality cannot afford to spend too much money on useless gadgets – yet, their current prosthetic arm research is nothing but absolutely useless money wasting for dreams, for visions, for technology they will never be able to sell to anyone for an even halfways acceptable price, with a halfways acceptable weight. It is done in the best of noble intention – glorify myoelectric arms and maximize income for gadget builders – but from a client’s perspective (you forgot that you came here, to read about “technical below elbow amputee issues, right?), that type of development and prosthetic sales strategy is not helpful. If they cannot build a body powered arm right, “cannot” is the operative word and “inability” is the proper characterization.

If you doubt that your prosthetic arm has been built right, get it checked. Get other people’s opinions. Tell your insurance to withhold payment until the job is done right.

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Prosthetic arms, hands and hooks and other orthopedic technical products. Swiss Disability Insurance. Swiss import regulations.; published July 4, 2011, 00:50; URL: http://www.swisswuff.ch/tech/?p=451.

BibTeX: @MISC{schweitzer_wolf_1411105628, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Prosthetic arms, hands and hooks and other orthopedic technical products. Swiss Disability Insurance. Swiss import regulations.}}, month = {July}, year = {2011}, url = {http://www.swisswuff.ch/tech/?p=451} }

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