frcpath in the uk). in france, only medical staff (pharm.d. and m.d. specialized in anatomical pathology or clinical laboratory science) can discuss laboratory results. medical laboratory accreditation credibility of medical laboratories is paramount to the health and safety of the patients relying on the testing services provided by these labs. credentialing agencies vary by country. the international standard in use today for the accreditation of medical laboratories is iso 15189 - medical laboratories - requirements for quality and competence. in the united states, billions of dollars is spent on unaccredited lab tests, such as laboratory developed tests which do not require accreditation or fda approval; about a billion usd a year is spent on us autoimmune ldts alone. accreditation is performed by the joint commission, college of american pathologists, aab (american association of bioanalysts), and other state and federal agencies. legislative guidelines are provided under clia 88 (clinical laboratory improvement amendments) which regulates medical laboratory testing and personnel. the accrediting body in australia is nata, where all laboratories must be nata accredited to receive payment from medicare. in france the accrediting body is the comité français d'accréditation (cofrac). in 2010, modification of legislation established iso 15189 accreditation as an obligation for all clinical laboratories. in the united arab emirates, the dubai accreditation department (dac) is the accreditation body that is internationally recognised by the international laboratory accreditation cooperation (ilac) for many facilities and groups, including medical laboratories, testing and calibration laboratories, and inspection bodies. in hong kong, the accrediting body is hong kong accreditation service (hkas). on 16 february 2004, hkas launched its medical testing accreditation programme. in canada, laboratory accreditation is not mandatory, but is becoming more and more popular. accreditation canada (ac) is the national reference. different provincial oversight bodies mandate laboratories in eqa participations like lspq (quebec), iqmh (ontario) for example. industry laboratoire de la muette, medical laboratory in paris the laboratory industry is a part of the broader healthcare and health technology industry. companies exist at various levels, including clinical laboratory services, suppliers of instrumentation equipment and consumable materials, and suppliers and developers of diagnostic tests themselves (often by biotechnology companies). clinical laboratory services includes large multinational corporations such labcorp, quest diagnostics, and sonic healthcare but a significant portion of revenue, estimated at 60% in the united states, is generated by hospital labs. in 2018, the total global revenue for these companies was estimated to reach $146 billion by 2024. another estimate places the market size at $205 billion, reaching $333 billion by 2023. the american association for clinical chemistry (aacc) represents professionals in the field. clinical laboratories are supplied by other multinational companies which focus on materials and equipment, which can be used for both scientific research and medical testing. the largest of these is thermo fisher scientific. in 2016, global life sciences instrumentation sales were around $47 billion, not including consumables, software, and services. in general, laboratory equipment includes lab centrifuges, transfection solutions, water purification systems, extraction techniques, gas generators, concentrators and evaporators, fume hoods, incubators, biological safety cabinets, bioreactors and fermenters, microwave-assisted chemistry, lab washers, and shakers and stirrers. united states main article: health technology in the united states in the united states, estimated total revenue as of 2016 was $75 billion, about 2% of total healthcare spending. in 2016, an estimated 60% of revenue was done by hospital labs, with 25% done by two independent companies (labcorp and quest). hospital labs may also outsource their lab, known as outreach, to run tests; however, health insurers may pay the hospitals more than they would pay a laboratory company for the same test, but as of 2016, the markups were questioned by insurers. rural hospitals, in particular, can bill for lab outreach under the medicare's 70/30 shell rule. laboratory developed tests are designed and developed inside a specific laboratory and do not require fda approval; due to technological innovations, they have become more common and are estimated at a total value of $11 billion in 2016. due to the rise of high-deductible health plans, laboratories have sometimes struggled to collect when billing patients; consequently, some laboratories have shifted to become more "consumer-focused".