Laboratory testing under managed care dominance in the USA

Area of Science:

• Health Services Research
• Clinical Laboratory Science
• Healthcare Management

Background:

• Rising healthcare expenditures in the USA have driven the growth of managed care organizations (MCOs).
• The managed care era presents significant financial challenges for traditional hospital-based laboratories.
• Regulatory changes, like the Clinical Laboratory Improvement Amendments of 1988, have also affected laboratory operations.

Purpose of the Study:

• To analyze the impact of managed care on clinical laboratories in the USA.
• To identify survival strategies for hospital laboratories amidst financial pressures.
• To predict the future landscape for hospital, physicians' office, and commercial reference laboratories.

Main Methods:

• Qualitative analysis of the healthcare and laboratory market dynamics.
• Review of strategic responses by hospital laboratories to financial challenges.
• Assessment of the impact of managed care infiltration and regulatory changes on laboratory types.

Main Results:

• Hospital laboratories are adopting strategies such as consolidation, networking, outreach testing, and point-of-care services.
• Physicians' office laboratories (POLs) face closure due to regulatory restrictions and managed care.
• Commercial reference laboratories are poised to benefit from contracts with MCOs.

Conclusions:

• Clinical laboratories in the USA are fundamentally altering their operations and missions due to managed care dominance.
• Hospital laboratories must adapt through strategic initiatives to remain financially viable.
• The market share is expected to shift, with commercial reference labs likely to expand.