The changing relationship between clinicians and the laboratory medicine specialist in the managed care era.

Largely because of increased health-care costs, a variety of managed-care programs have been developed, and payment plans based on capitation will probably predominate in the future. Capitated, per-case, or per diem payment plans alter the traditional independence of health-care providers from the payment system. In these systems, clinical laboratory use becomes a resource to be managed, rather than a neutral third party or a source of income. Under capitated payment systems, clinicians will be motivated to reevaluate their own clinical laboratory resource use. Successful laboratory medicine specialists will understand these trends as well as the impact of newer payment plans on the relationship between themselves and clinicians, and develop new strategies to work with clinical colleagues to effect change.