SIC 8099
HEALTH AND ALLIED SERVICES, NOT ELSEWHERE CLASSIFIED



This classification is comprised of establishments primarily engaged in providing health and allied services, not described under other classifications.

NAICS Code(s)

621991 (Blood and Organ Banks)

541430 (Graphic Design Services)

541922 (Commercial Photography)

621410 (Family Planning Centers)

621999 (All Other Miscellaneous Ambulatory Health Care Services)

Industry Snapshot

This segment of the health services industry includes an array of services and occupations that most often do not involve the provision of direct care. Rather they provide diagnostic services or facilitate the work of physicians and other health care providers.

Despite the extreme diversity of establishments in this classification, all enjoy the economic advantages of offering services that are in great demand regardless of economic climate. The establishments include blood banks; hearing testing services; childbirth preparation classes; health screening centers, except by physicians; sperm banks; osteoporosis centers; medical illustration; oxygen tent services; and plasmapheresis centers. In 1997, the industry had total revenues of just under $23 billion; by 1998 the industry employed 339,000 people.

The classification contains a notable mix of profit and non-profit organizations. Blood banking, for example, is a multi-billion dollar industry in which the purified products, though donated, command a high price if sold. Hearing testing services may be available for free at schools or for a fee at private commercial establishments. Most hearing testing is done in schools and colleges, with 10 percent in hospitals and the rest in private offices and speech, language, and hearing centers. Similarly, childbirth preparation classes are often available through schools, community groups, and other nonprofit organizations, but they are also available from commercial childbirth preparation centers. Health screenings are done by municipal health departments as well as independent commercial establishments. Unlike the rest of the activities on this list, medical equipment like oxygen tents are profit-making ventures, while medical art and photography may be provided by independent entrepreneurs contracted by medical textbook publishers or others engaged in medical education.

The state of the nation's health has had a great impact on two of the health services in this group — the collection and production of blood. Combined, this sector, the most lucrative in this classification, has been much affected over the last decade by the need to test for hepatitis and AIDS. The same concerns hold true for sperm banks.

Organization and Structure

Since there is such a diversity of activities within the health and allied services group, there is no overall industry structure. Rather, different structures govern each activity. For example, in the case of blood banks, three nonprofit organizations preside over the $3 billion U.S. whole blood market.

At the end of the 1990s, the leading blood market organization was the Red Cross, which had 38 regional blood centers that collected blood from more than 4.5 million donors, and supplied more than half of the nation's blood supply. The number of blood centers the previous year was 45, however, the organization was forced to restructure their blood bank operations after questions arose regarding their quality standards. The 1996 restructuring cost approximately $162 million.

The Red Cross was estimated to have $1.9 billion in revenue in 1997. A majority came from biomedical services (the collection, testing, and distribution of blood and blood components); revenue derived solely from these activities accounted for $1.1 billion.

Second to the Red Cross is America's Blood Centers (ABC), a nation-wide network of independent blood centers in 46 states at over 450 sites. Their mission also included blood diagnostic and therapeutic services. In 1999, ABC collected approximately 47 percent of the blood used in the United States.

Industry Divisions. The miscellaneous services provided in the health and allied services industry can be subsumed into two general groupings: first, services provided to physicians and hospitals; and second, services provided to health care consumers.

The services provided to physicians and hospitals include medical photography and art and blood and blood products from blood and plasmapheresis centers. Medical or biological subjects may be illustrated for teaching purposes through photography, graphics, paintings, and three-dimensional models. Medical art and photography appears in books, films, videotapes, and computer graphics. Blood banks provide whole blood and some derived components that are processed, typed, and stored until needed for transfusion. Blood should be used as soon as possible since the number of red blood cells decline significantly after 14 days. At plasmapheresis centers, blood is removed from the body, centrifuged, and the red cells suspended in a solution. They may be re-injected into the donor or into a patient who requires red cells rather than whole blood.

Examples of services provided to health consumers include health screening, hearing testing, child birth preparation classes, sperm banks, and osteoporosis centers.

Health screening centers, whether private or public, are likely to focus on particular problems such as cancer detection; sexually transmitted diseases; or nutrition, diet, and weight control.

Hearing centers diagnose hearing problems and prescribe treatment. An audiologist uses an audiometer and other testing devices to measure the loudest sound at which a person begins to hear. The audiologist also measures the ability to tell the difference between sounds and the extent of any hearing loss. The results of the tests may be correlated with other medical, psychological, and education test results and a course of treatment determined.

Childbirth preparation classes often follow the principles of the French obstetrician Fernand Lamaze, who advocated avoiding highly medicated childbirth. The method stresses the active participation of the mother through muscle control and breathing, with encouragement and massage given to her by her husband. In this method, also known as pyscho-prophylaxis, the husband is prepared to act as his wife's labor coach.

The fact that sperm can be kept alive for long periods of time in cold temperatures has enabled banks of human semen to be maintained for use in artificial insemination. Licensed sperm banks are members of the American Fertility Society. The society has revised its guidelines for therapeutic donor insemination of sperm several times in recent years to improve selection of donors and decrease the potential hazard for transmitting infectious agents.

Current Conditions

As in general medical professions, there are controversies within this classification regarding the right of physicians to refer patients to establishments in which they have invested. In 1993, the Federal Trade Commission used antitrust legislation to challenge two oxygen and oxygen equipment businesses owned by doctors who referred their patients to them. According to the Federal Trade Commission, 60 percent of the lung specialists in two California counties, Contra Costa and Alameda, had invested in the medical equipment companies. The Commission stated that such "self-referrals," as they are called, exclude competitors from the market in violation of the law since the doctors can control the referral of patients who need these services. Since other home oxygen companies may not be able to get referrals from doctors, they were unable to compete in the market regardless of the quality or prices. The commission and the companies agreed on a settlement, stipulating that some of the lung specialists would have to sell their shares in the company so that no more than 25 percent of the lung specialists in the area would have a connection with the company.

The need to protect the blood supply against hepatitis and AIDS has made the work of blood banks and plasmapheresis centers increasingly complex. To screen against the two diseases, blood centers have added five tests since 1985. Commercial companies and nonprofit blood centers have acquired computer systems to track donors throughout the country. The American Blood Resources Association is setting up a nationwide donor referral registry, so that a blood center can call an 800 number to find out if the donor has ever tested positive for the AIDS virus or another condition that would rule them out as a donor. Aware of public concern over the safety of the blood supply, the American Association of Blood Banks in 1993 mounted a public relations program designed to increase public awareness about the general safety of the blood supply.

Plasma, in particular, is the fastest growing sector of the blood products industry. There is a worldwide market for blood plasma. A pint of whole blood has a $100 price tag, but its components add up to $190 a pint. Plasma lasts longer than blood and $55 worth of plasma can be extracted from a pint of blood. The technology and training for processing plasma requires a significant investment. Obtaining plasma may often involve paying donors. Plasma can be separated into albumin, which is necessary to keep blood vessels from collapsing after an injury; factor VIII, an important blood clotting agent; and immune globulins, which can protect against several diseases.

With 30 percent market share, the leader in the industry is Armour Pharmaceutical Company (of Bluebell, Pennsylvania), a subsidiary of Rhone-Pulence Rorer, the French government-owned pharmaceutical company. Next, with 25 percent of the market, is Hyland Therapeutics (of Glendale, California), a subsidiary of Baxter International Inc. The Red Cross became involved in the commercial market in 1978 when it took donated plasma from its supplies and used the Hyland manufacturing facilities to turn it into its marketable components. That move brought the Red Cross approximately $100 million of tax-exempt revenue in 1990. By 1996, the Red Cross had become a $1.9 billion organization.

The blood and blood products sector is the most highly regulated sector within this classification. The U.S. Food and Drug Administration (FDA) licenses plasmapheresis firms as well as the firms that ship their products from state to state. The problems that were uncovered at a Tacoma, Washington plasmapheresis center illustrate the risks involved when this type of firm does not adhere to regulations. The firm, AVRE Plasma, received a four-month suspension of its establishment and product licenses in 1992 as a result of operating practices that the FDA termed "dangerous." AVRE sells source plasma to pharmaceutical firms for processing into serum albumin, immune globulins, and other medical products.

Workforce

The training required to carry out the duties of the health and allied services listed here varies greatly. Medical illustrators generally have a four-year bachelor's degree, and often from one of the six accredited schools in the United States that offer a degree in medical illustration. Audiologists also have four years of training, but with a master's degree, may acquire the Certificate of Clinical Competence offered by the American Speech and Hearing Association. They must also have 300 hours of supervised clinical experience in a 9-month, postgraduate internship, and pass an examination. In contrast to the extensive training required by others in this category, phlebotomists can be trained to draw blood in from one to three months. However, much more extensive training is required for the technicians who analyze blood to determine if there are abnormalities; hence, the medical director of a blood bank is often a pathologist with a full medical degree.

Research and Technology

The blood industry will require huge infusions of money early in the twenty-first century to purchase new equipment for research and employ more staff. The commercial blood products companies have invested $50 million for research into new blood products; the Red Cross has invested $7 million alone.

The advent of the AIDS epidemic has also resulted in people storing their own blood in preparation for operations or emergencies. The first autologous blood storage was done by a sperm bank owned by the Daxor Corporation, based in New York. The blood can be stored for 10 years, and storage charges vary from $12 a month for a pint of fragile red cells to $8 for plasma. Autologous blood banks have not been a good investment, according to Dr. Joseph Feldschu, who founded Daxor. Acceptance of this approach has been slow. Traditional blood banks also consider that autologous blood threatens the system of voluntary blood donations for others.

Reports at the 1994 American Association of Blood Banks Conference showed how new technologies could reduce or even replace the need for blood transfusions. One such technology involves the transplantation of purified peripheral blood progenitor cells, which are collected through an immuno-absorption system. In tests at the University of Colorado Cancer Center in Denver, patients showed improvements in their recovery rate. "Patients are recovering faster, doing better, and getting out of the hospital more quickly, which translates into reduced costs," Shelly Heimfeld, director of biological research at CellPro in Washington, told JAMA. "Peripheral blood also dramatically reduced the number of red blood cell and platelet transfusions needed."

In 1999, under the auspices of the Federal Drug Administration's Investigational New Drug (IND) application process, the blood community began Nucleic Acid Amplification Testing (NAT). This new technology specifically sought increased protection of the nation's blood supply by detecting genetic material that marked HCV and HIV viruses.

The medical illustration industry benefited greatly from computer technology innovations in the mid to late 1990s. By 1997, illustrators had access to more techniques, such as three-dimensional scientific imaging, surface modeling, and animation. In addition, medical illustrators could use laser scanners and digitizers to enhance detail and accuracy. Illustrators could also manipulate three-dimensional information using the virtual reality modeling language (VRML) to put biological models and data on the World Wide Web for examination by medical students, patients, and consultants.

Further Reading

"ABC Foundation." Washington: America's Blood Centers, 1999. Available from http://www.americasblood.org/ .

Darnay, Arsen J., ed. Service Industries USA, 3rd edition. Farmington Hills, MI: Gale Group, 1996.

Finkelstein, Katherine Eban. "Blood Money: Liddy Dole's Red Cross Runs Amok." The New Republic, 12 August 1996.

Hansen, David J. "New Computer Techniques for Medical Illustration and Scientific Visualization." JAMA, 5 February 1997.

"Industry Report-Health and Allied Services, Not Elsewhere Classified." National Industry Operation Matrix. Washington: Bureau of Labor Statistics, 1999. Available from http://stats.bls.gov/asp/oep/nioem/ .

Scott, Lisa. "Red Cross Touts Its Broad Restructuring." Modern Healthcare, 13 November 1995.

True Stories: 1997 Annual Report. Washington: American Red Cross, 1997.

U.S. Department of Commerce, Bureau of the Census. Service Annual Survey: 1997. Washington: GPO, 1999.



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