The microeconomics of the assistive technology access gap: Demand, supply, market failures, and the case for hybrid provision models

Background The 2022 WHO–UNICEF Global Report on Assistive Technology documented that 2.5 billion people need at least one assistive product, yet nearly one billion of them lack access; coverage ranges from approximately 3% in the lowest-income settings to 90% in high-income settings. While clinical and social explanations for this gap are well rehearsed, the assistive technology (AT) literature has engaged less systematically with microeconomic theory, even though the access gap is, in part, the product of a market that does not behave like a textbook competitive market. Purpose This perspective article applies a microeconomic framework to the AT ecosystem in order to (i) describe the demand and supply structure of AT markets, (ii) identify the specific market failures that produce the access gap, (iii) analyse the welfare consequences of those failures, and (iv) map a corresponding menu of policy instruments onto the failures they are best suited to address. Approach A narrative review, drawing on published health-economics literature, WHO and UNICEF reports, and AT service-delivery studies, was synthesised through four microeconomic lenses: consumer choice under heterogeneity and information asymmetry; production economics and market structure; externalities and merit-good arguments; and the welfare economics of public provision. Examples are drawn from mobility, hearing, vision and digital cognitive AT. Conclusions The AT access gap is consistent with a market characterised by simultaneous demand-side, supply-side and information-related failures rather than a simple shortage of devices. Subsidy- or device-only models address one symptom while leaving others untreated. The article argues for hybrid provision models that combine targeted financial instruments (vouchers, insurance, tiered pricing) with non-financial instruments (matching services, open standards, regulated information disclosure, workforce development) and treats mainstream digital products as a legitimate component of public AT systems. The framework offers a structured way for AT researchers, clinicians and policymakers to diagnose access problems and to align policy responses with the underlying economic mechanism.