Where Industry and Security Intersect
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Each year, thousands of people around the world are confronted with some form of disability as a consequence of an accident, aging, disease, or other causes-and they wonder how they will cope. For others, it may be just another day of living with a disability, which they may have had since they were young. Regardless of when people develop a disability, they have a common cause-to identify and use, whenever possible, devices that enable them to lead a normal life and to be more productive.
U.S. manufacturers of "assistive technologies" (AT) are doing much to meet the needs of people with disabilities, producing thousands of products to address many conditions. Assistive technology is defined as encompassing any kind of process, system, or equipment that maintains or improves the capabilities of people with disabilities of any kind - physical or cognitive. Examples of AT products include hearing aids, talking books, braille computer displays, orthotics/prosthetics, and wheelchairs. See Table 2 for a more inclusive list.
The 359 companies who responded to the BIS survey reported sales in 1999 of $2.87 billion, with sales growing 21.8 percent from 1997 to 1999. The industry manufactures more than 17,000 products, and BIS survey respondents employed just over 20,000 workers in 1999 in a mix of small, medium, and large businesses. Sixty percent of responding firms have 10 employees or less. Eleven percent of the responding firms accounted for 69 percent of the revenue.
There are questions, however, about the future of U.S. AT companies, specifically their ability to continue to grow and innovate. To varying degrees, the industry is thwarted by the size of product markets, which can be very small, making it difficult for companies to generate revenues sufficient to attract investors and discouraging them from making their own investments in R&D and manufacturing capacity.
Also, some industry survey respondents expressed concerns about how cumbersome public and private insurance program participation procedures and outdated compensation methodologies may stifle innovation in AT product development, and distort industry market forces. Public and private insurance programs decide which AT devices they will reimburse end-users for, as well as the amount of the reimbursement. Because AT manufacturers are uncertain of when and under what reimbursement structure they will be permitted to sell their product, many product ideas remain on the shelf, according to survey data collected by BIS from more than 359 companies.
Conversations with company executives, in addition to survey data and written comments from companies, suggest that some product qualification and repayment processes within federal and state agencies may be in need of revision. There are two purposes in such action: 1) to create a more positive climate for innovation and sales in the AT industry; and 2) to ensure that people with disabilities are not denied access to products that can make their lives better.
At the same time, the economic status of many people with disabilities prevents them from acquiring the AT products they need. Many have inadequate private insurance, or are dependent on budget-constrained state and federal health agencies to provide partial or full funding of assistive devices.
Approximately 50 million Americans have some kind of disability-17.5 percent of the 285 million people who reside in the United States. Almost half of the people in this group are considered to be coping with a severe disability.4 In sheer numbers, the population of people with disabilities in the United States is certain to grow dramatically as the population ages. In 2001, the U.S. Census estimates that there are 59.6 million people living in the United States who are 55 years of age or older. The figure is projected to skyrocket to 102.7 million by 2025.5
Industry and government must rethink the way they work independently and together in order to better serve the American public; maintain market share in the domestic market; to expand sales of American-made AT products in markets overseas; and to incorporate defense and other cutting-edge technologies into AT products. A key challenge for the U.S. assistive technology industry is to effectively penetrate the underserved and unserved market base of Americans with disabilities.
Achieving this goal requires multiple actions on the part of the industry: 1) improving manufacturing efficiency and technology insertion, and fielding new designs to lower production cost; and 2) increasing awareness among people with disabilities of the availability of AT products for specific disabilities. Industry noted in its responses to the BIS survey that state and federal health agencies, regulators, and legislators need to provide more flexibility in administering medical assistance programs that provide AT products to people with disabilities.
At the same time, the U.S. manufacturers of AT devices and interest groups representing people with disabilities need to work more closely with the state and federal governments. New authority and direction may be required to bring about changes in procedures governing the certification of AT equipment; and to increase funds for AT equipment that people with disabilities cannot obtain because of insufficient income or insurance.
In addition, many AT manufacturers operating in the United States might leverage their capabilities and improve product quality by taking advantage of technical resources and intellectual property available at Department of Defense and civilian federal laboratories. Survey data show that a large number of AT companies, many with limited technical resources, have had little or no interaction U.S. Government research organizations.
Finally, federal and state agencies need to revise procedures and adopt policies to encourage greater innovation in the AT industry and to support the AT manufacturing and services industry in the United States. The aim should not only be to serve domestic needs, but to foster expansion of the U.S. AT industry and to boost exports of U.S. AT products and services.
5 www.census.gov/ftp/pub/population/projections/nation/summary/np-t3-f.txt