Hutchinson incisors and mulberry molars are seen when an ind…

Questions

Hutchinsоn incisоrs аnd mulberry mоlаrs аre seen when an individual was congenitally affected by ______________.

Reаd the fоllоwing cаse mаterial and prepare tо answer questions 11-12: In 1993, U.S. manufacturers’ sales of standard wheelchairs were about $130 million and were forecast to grow by 5% annually for the next several years. Made of steel with vinyl upholstery, standard wheelchairs weighed 36 to 50 pounds and were folded to a thickness of 10 inches. Suggested retail prices ranged from $400 to $850. Wheelchairs were manufactured in a labor-intensive cutting, bending, welding, and assembly process. No competitor had a significant patent. Fully integrated manufacturing required a $1 million investment in machine tools. Manufacturers set suggested retail prices of wheelchairs to conform to Medicare guidelines. Discounts at the wholesale level were more common than retail discounts. According to standard industry practice, the wholesale price paid by the dealer to the wheelchair manufacturer was 60% of the suggested retail price. Large dealers negotiated additional discounts and paid as little as 42% to the manufacturer. The nation’s 10,000 wheelchair dealers varied in their sizes and approaches to the marketplace. Seventy percent operated at one or two locations. The smallest were independent pharmacies. Only about a dozen large chains and buying groups had sales of more than $10 million. Almost every dealer carried products from all manufacturers. The selling process for wheelchairs could involve contact between dealers, physical therapists, physicians, patients, and insurance companies. Seventy-five percent of wheelchair sales in the U.S. were at least partially covered by insurance. The hallmark insurance program was Medicare, which covered 34 million elderly and disabled people in 1993. Wheelchairs qualified for Medicare reimbursement if they were deemed “medically necessary” by a physician. Competition in the U.S. wheelchair market was dominated by Everest & Jennings (E&J) International, Invacare Corporation, and Sunrise Medical, Inc. Exhibit 1 shows the share of revenue split across these three companies in 1993. Exhibit 2 illustrates the changing market share of the industry from 1978 to 1993. Besides the three dominant players in this industry, there are only a handful of wheelchair manufacturers that can compete with the “big three” at similar price points.  A price war between Invacare and E&J was fierce in the 1980s, but it began to abate around April 1990, after Invacare opened its Mexican production facility. Invacare, the lowest-cost producer of standard wheelchairs, manufactured its products in a new Mexican facility where it had invested several million dollars in equipment. Assemblers could enter with only a $300,000 investment if they purchased prefabricated parts, which were available from several Taiwanese companies at prices about 10% higher than Invacare’s costs of manufacture. Raw materials accounted for 70% to 80% of total manufacturing costs and consisted of commodities available from many suppliers. Exhibit 1. Share of 1993 Revenue by Competitors Name of the Manufacturer E&J Invacare Sunrise Market Share 15% 37% 20%   Exhibit 2. Changing Revenue Composition of the U.S. Wheelchair Manufacturers (1978-1993)