Takemura Y, Beck J R
Pathology and Information Technology Programme, Baylor College of Medicine, One Baylor Plaza, Room 126E, Texas Medical Centre, Houston, Texas 77030-3498, USA.
J Clin Pathol. 2001 Feb;54(2):89-95. doi: 10.1136/jcp.54.2.89.
The uncontrolled escalation of total health care expenditure despite the government's endeavours during the past decades in the USA had led to the rapid infiltration of managed care organisations (MCOs). Traditional hospital based laboratories have been placed in a crucial situation with the advent of the managed care era. A massive reduction of in house testing urged them to develop strategies against financial difficulty. Consolidation and networking, participation in the outreach testing market, and emphasis on point of care/satellite laboratory testing in non-traditional, ambulatory settings are major strategies for the survival of hospital laboratories. Several physicians' office laboratories (POLS) have closed their doors in response both to regulatory restrictions imposed by the Clinical Laboratory Improvement Amendments of 1988 and to managed care infiltration. It seems likely that POLs and hospital laboratories will continue to reduce test volumes, whereas commercial reference laboratories will thrive through contracting with MCOs. In the current climate of managed care dominance in the USA, clinical laboratories are changing their basic operation focus and mission in response to the aggressively changing landscape.
尽管美国政府在过去几十年中付出了努力，但医疗保健总支出仍不受控制地攀升，这导致了管理式医疗组织（MCO）的迅速渗透。随着管理式医疗时代的到来，传统的医院实验室陷入了关键境地。内部检测的大幅减少促使它们制定应对财务困境的策略。合并与联网、参与外部检测市场，以及在非传统的门诊环境中强调即时检测/卫星实验室检测，是医院实验室生存的主要策略。几家医师办公室实验室（POLS）因1988年《临床实验室改进修正案》施加的监管限制以及管理式医疗的渗透而关闭。POLS和医院实验室似乎将继续减少检测量，而商业参考实验室将通过与MCO签约而蓬勃发展。在美国当前管理式医疗占主导地位的环境下，临床实验室正在根据急剧变化的形势改变其基本运营重点和使命。
