[The future of clinical laboratory medicine--a viewpoint from hospital administration]

Net profits estimated from the operation of about 10,000 public and private hospitals here in Japan, showed a 0.6 per cent decrease in 1991. This reflects the severity of hospital management under governmental policy requiring the rate of increase in medical expenses to be less than the rate of increase for the GNP. Changes in medical fee reimbursement in the National Health Insurance in April 1992, reduced the fees for many medical tests, resulting in decreased income especially in outpatient clinics. Because of this, it is necessary to review the maintainance or existence of hospital laboratories from the standpoint of medical needs and cost efficiency. Laboratory tests must be done promptly, even on holidays. Only hospital laboratories can do this. Many bedside tests will need to be instituted. Doctors preferably, or technicians should fully explain the need for tests to the patient. "Informed consent" is important. Test results should be reported to the doctors not only with the test data, but also with interpretation by clinical pathologists to expedite the doctor's decision or diagnosis. The need for commercial laboratories is increasing because of difficulty caused by new and expensive equipment and techniques of modern laboratory service even in large hospitals. Commercial laboratories should serve not only as a subcontractor, but also as symbiotic partner of hospitals, clinics or medical offices in both medical and business management.