[The situation of clinical examination in today's U.S. hospitals]

In the U.S., with the spread of managed care such as the Diagnostic Related Group/Prospective Payment System(DRS/PPS) introduced in 1983 into Medicare, the national elderly medical insurance system, and the Health Maintenance organization introduced in 1990 in the private medical insurance system, medical services have become limited, and remuneration of medical practice has been markedly restricted. As a result, hospital management has been pressed, and cooperation, merger, and absorption among hospitals as is observed among general enterprises have occurred. Hospitals have been making efforts to reduce expenses for survival. I introduced a part of the influence of such revisions in medical insurance systems on the medical care system, particularly the clinical examination field, by reporting the present state of the Beth Israel Medical Center(BIMC, New York) for which I have cooperated in the management of the Central Examination Room for many years, and information obtained in the UC. San Francisco Medical Center and Peninsula Hospital I visited when attending the meeting of the American Association of Clinical Chemistry(AACC) held in San Francisco on July 23-27, this year.