Medical screening and biological monitoring for the effects of exposure in the workplace. Review of 30 years of screening practices.

Increasingly larger proportions of our population are insured against health care costs through negotiated or mandated contracts involving active and retired workers and their dependents. Seeking to control and contain the dramatically rising costs, employers have begun ti demand full accountability from their third-party payers, in response to which the health care services delivery system is evolving health maintenance organizations, preferred provider organizations, independent practice associations, and variant aggregates of participants with more homogeneously predictable utilization rates and cost estimates. The resultant information base generates employer-specific data leading to earlier detection and identification of work-related and total premorbidity and morbidity, causing renewed emphasis on prevention through total, including work-site related, risk-factors reduction. The screening technology required for the implementation and evaluation of health risks assessment and reduction programs is reviewed. The technology has matured significantly over the past 30 years. Problem areas and action needs are identified.