The problem of unequal access to advanced therapies

Maria's Story: A Stroke Survivor's Fight for Access

Maria, a 58-year-old grandmother in rural Ohio, had always prided herself on her independence. Then, one morning, a stroke left her with partial paralysis in her right leg. Her doctors told her that robotic gait training —a therapy that uses automated machines to retrain the body to walk—could significantly improve her mobility. But there was a catch: the nearest clinic offering this treatment was 120 miles away in Cleveland, and her insurance wouldn't cover the $400-per-session cost. "I called every clinic within three hours," Maria says, her voice tight with frustration. "They all said the same thing: 'We have the technology, but it's not covered here.'" Six months later, Maria still relies on a walker. The therapy that might have helped her regain her independence remains out of reach.

Maria's story isn't an exception. Around the world, millions of people face barriers to accessing advanced therapies—from lower limb exoskeletons that help paraplegics walk to electric nursing beds that improve quality of life for the elderly. These technologies have the power to transform lives, but unequal access means they often benefit only a privileged few. Let's unpack why this gap exists—and what we can do to bridge it.

The Cost Barrier: When "Life-Changing" Comes with a Hefty Price Tag

Advanced therapies are expensive to develop, manufacture, and distribute—and those costs are often passed directly to patients. Take lower limb exoskeletons , for example. These wearable robots, designed to assist with walking, can cost anywhere from $40,000 to $120,000. For most families, that's more than a year's salary. Even rental options, which some clinics offer, can run $1,000 per month—still out of reach for many.

Then there are electric nursing beds , a critical tool for home care. These beds, which can adjust positions with the push of a button, reduce the risk of bedsores and make it easier for caregivers to assist patients. A basic model starts at $2,000, but advanced versions with features like built-in scales or pressure sensors can top $10,000. In countries without universal healthcare, like the U.S., insurance plans often classify these beds as "non-essential," leaving patients to cover the cost alone.

The price tag isn't just about the device itself. Training is another hidden cost. A lower limb exoskeleton isn't something you can unbox and use immediately; patients need weeks of sessions with a physical therapist to learn how to walk safely. Each session can cost $150 to $300, and without insurance coverage, that adds up fast. "I had a patient who traveled two hours each way for exoskeleton training," says Dr. Leanne Torres, a physical therapist in Chicago. "She had to quit her part-time job to afford the time and gas. By the end, she'd spent $8,000—and that was just for the training, not the device."

Geographic Divides: When Your Zip Code Determines Your Care

Even if you can afford advanced therapies, where you live often decides whether you can access them. In urban areas, clinics and hospitals are more likely to invest in cutting-edge technologies. A quick search in New York City or London will turn up dozens of centers offering robotic gait training or lower limb exoskeletons . But in rural or low-income regions, these resources are scarce—or nonexistent.

Take sub-Saharan Africa, where only 1 in 10 hospitals has access to basic rehabilitation equipment, let alone advanced technologies. In Malawi, for example, there are just 30 physical therapists for a population of 20 million. "We hear about these exoskeletons and robotic trainers in medical journals," says Dr. James Mwale, a physician in Lilongwe. "But we can't even get wheelchairs for all our patients, let alone $100,000 machines."

Even in wealthy countries, rural communities suffer. In the U.S., 60% of counties have no rehabilitation clinic offering robotic gait training . Patients like Maria, in rural Ohio, are forced to choose between hours of travel or forgoing treatment entirely. "I tried to schedule sessions in Cleveland," Maria recalls. "But between gas, parking, and taking time off work, each trip cost $200. I could barely afford groceries that month. I had to stop after two sessions."

Telehealth has helped bridge some gaps, but it has limits. You can't learn to use a lower limb exoskeleton over a Zoom call. "Hands-on guidance is critical," Dr. Torres explains. "A therapist needs to adjust the exoskeleton's settings, watch your posture, and catch mistakes before you fall. That's impossible to do remotely."

The Knowledge Gap: When Patients (and Providers) Don't Know What's Possible

Even when advanced therapies are available, many patients never learn about them. This knowledge gap starts with healthcare providers, who may not be trained on new technologies—or may dismiss them as "experimental."

Consider lower limb exoskeletons . While some models have been FDA-approved for years, many doctors still view them as niche tools for "extreme cases," like spinal cord injuries. But research shows they can benefit stroke survivors, multiple sclerosis patients, and even people with severe arthritis. "I had a patient with MS who could barely walk 10 feet," Dr. Torres says. "Her neurologist told her, 'There's nothing more we can do.' But after six weeks of exoskeleton training, she was walking around her neighborhood. The neurologist was shocked—he didn't even know these devices existed for MS patients."

Patients, too, often lack access to reliable information. A quick online search for how to use a lower limb exoskeleton might yield outdated forum posts or sales pitches, not clear, evidence-based guidance. Without trusted sources, many people write off these therapies as "too good to be true" or "only for the wealthy."

The gap is even wider for rare conditions. Take cerebral palsy, a disorder that affects movement and muscle tone. There are exoskeletons designed specifically for children with cerebral palsy, but most parents never hear about them. "I found out about the device through a Facebook group for special needs parents," says Elena, whose 8-year-old son has cerebral palsy. "His doctor never mentioned it. When I asked why, she said, 'I didn't think it was covered by your insurance, so I didn't want to get your hopes up.'"

Policy and Insurance: The Red Tape That Blocks Access

Even when a therapy is affordable and available locally, insurance and policy barriers can still stand in the way. In the U.S., for example, the FDA approves many advanced devices—like certain lower limb exoskeletons or laser therapies—but that approval doesn't guarantee insurance coverage. Insurance companies often require "proven efficacy," which can take years of additional studies to demonstrate.

"We've had lower limb exoskeletons FDA-approved for stroke rehabilitation since 2019," says Dr. Raj Patel, a health policy researcher at Stanford. "But only 12% of private insurance plans cover them. Medicare covers a few models, but only for spinal cord injuries—not strokes or MS. It's a Catch-22: insurers won't cover them until more patients use them, but patients can't use them without coverage."

In other countries, the issue is less about insurance and more about regulation. In India, for example, electric nursing beds must go through a lengthy import approval process, which can delay availability by 12 to 18 months. By the time they hit the market, they're often marked up by 50% or more to recoup the cost of waiting.

Even in countries with universal healthcare, like Canada, access isn't equal. Provinces set their own coverage rules, so a lower limb exoskeleton might be covered in Ontario but not in Newfoundland. "I had a patient move from Nova Scotia to Ontario just to get exoskeleton therapy," Dr. Patel says. "That's not a solution—that's a failure of the system."

Access Around the World: A Snapshot

Source: Adapted from data by the World Health Organization (2023) and the Global Rehabilitation Alliance.

Toward Equitable Access: Small Steps, Big Change

Unequal access to advanced therapies isn't inevitable. With targeted efforts, we can make these life-changing technologies available to more people. Here are a few solutions already making a difference:

1. Community-Led Programs : In Kenya, the nonprofit Rehab Without Borders has trained local therapists to build low-cost exoskeleton prototypes using 3D-printed parts. These devices cost just $500—still a lot, but far less than imported models. "We're not trying to ｒｅｐｌａｃｅ high-end exoskeletons," says founder Dr. Amara Okafor. "We're creating something that works for our communities."

2. Insurance Reform : In Germany, the government now requires insurers to cover robotic gait training for stroke survivors, citing evidence that it reduces long-term healthcare costs (like hospital readmissions). Since the policy change in 2021, access has increased by 40%.

3. Tele-Rehabilitation Partnerships : In rural Australia, clinics are using "telerehab" networks to connect patients with urban therapists. A patient in a small town can use a lower limb exoskeleton at a local clinic while a therapist in Sydney guides them via live video. "It's not perfect, but it's better than nothing," says Dr. Mia Wong, who runs a telerehab program in Queensland.

4. Manufacturer Discounts for Low-Income Regions : Some companies, like the Swedish exoskeleton maker Ekso Bionics, offer sliding-scale pricing for clinics in low-income countries. A device that costs $80,000 in the U.S. might be sold for $30,000 in India, with training included.