LABORATORY TESTS: A TIME FOR CUTTING OFF COSTS!

DR. SALWA AL-ANSARI

CLINICAL BIOCHEMISTRY DEPARTMENT

JABER AL- AHMAD ARMED FORCES HOSPITAL, MINISTRY OF DEFENSE: KUWAIT

Introduction:

Health care services

1- Preventive

Surveillances and epidemiology

Diseases control &prevention

2- Mother r & Child

Pregnancy

Birth

Childhood

3- Primary health services

Patient’s Every day health services:

Medical practitioner

Assistant health services

Assistant health servicesX- rayPhysiotherapyPharmacyClinical LaboratoryAmbulance & Paramedics …etc

Clinical Laboratories:

Clinical BiochemistryHematologyMicrobiology(incl. serology & Parasitology)Histopathology

Laboratory service providers:

Hospital based lab.

Physician based lab

Independent clinical lab

Specialty:Surgical specimenblood transfusion and coagulationCBCAllergyAcute phase reactants

Full biochemical profileHormonesTumor markersTrace elements & VitaminsCulturesUrine routineSemen analysis…….etc

Laboratory Tests:

Screening

Diagnostic

Treatment

Follow up

Statistics: Depends?Billions of tests yearly!Important for patients! Where is the problem ?Not neededToo oftenLeads to more procedures False +ve results

24 hours working plan

Increased number of ordered tests

↑↑Pressure on the lab

More staff more reagents

↑↑laboratory budget & Cost of service

“WHO”: Many health systems are underfunded and even the well–funded ones are under economic pressure due to increasing demand and cost inflation. In these scenarios, laboratory services are often accorded low priorityand inadequate allocation of “resources.

≈ 70% of health decisions involving laboratory results

>10 % total hospital admission tests.

≈ lab cost 24 % hospital bill

Increased # tests? Is it crucial?

Responsibility??

80 % clinicians

Patients

Staff

Companies or new technology

Internet

Preventive measures

Cost of a test:1- Variable:Operating expenses & reagnets Stat testing

Salaries

troubleshooting

Replacement parts

Re-running controls & specimens

Overtime?

Delayed results →→ ↑↑length of stay

2- Fixed:

Administrative

Equipment

Building

Electricity & water

Costs:/ Kuwait

Ministry health :3rd largest public sector employer.

Total expenditure on Health: 6.7 % budget (2002-2003).

Non profit community hospital

Average biochemical routine tests cost 3-10 k.D

Special tests 2.5-321.5 k .D

10% of tests results left uncollected!

Tests re- 0rdered again after couple of weeks

Extra –tests added

j. A. A.F.H capacity ≈ 200 beds

Average samples 15359 / month.

clin. Biochemist. :an attempt to ↓ unnecessary test during October 2010.

Total lab. Tests number was average

but:

Biochemical tests ↑ 121 %. Calculate the cost?

Was is it necessary????

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Series1

1473015365

14223 14471

15441

14223

1661517208

16282

17681

1547815820

18426

15399

17062

13189

14573

9826

15815

10/08 8/08 5/08 6/08 12/08 6/08 4/08 1/09 3/09 5/09 4/09 10/09 1/10 3/10 4/10 5/10 6/10 8/10 10/10

Number of tests carried out during specified months (2008-2010)

October 2010

1 20

1000

2000

3000

4000

5000

6000

7000

Routine Spe-cial

October 2008

October 2009

Number of tests for clinical biochemist. Depart. During October 2008-2010

Still too many results not collected

Why? !

Any effect on service quality?

Are there any corrective measures?

Our step:

Single central

Very. Small

Limited duration

What we need ?

Inform the patients and clinicians cost of each test.

Cost analysis study “experience studies”.

Establish lab ethics & roles

Share information: clinicians (causality ,outpatients) & lab.

Physicians education programs

Government price control .

National Standardization

Correct the implemented decentralization, privatization and commercialization

Strengthen laboratories to provide critical inputs in making informed decisions

Multiple strategies & communications.

Changing the Disease specific lab.

AccessCoverage

QualitySafety

Financing

Health Workforce

Information

Medical products & technologies

Service delivery

Leadership/Governance

Improved health (level & quality)

Responsiveness

Social financial risk protection

Improved efficiency

WHO Health system Framework; Geneva, WHO , 2007

Cost effectivenessCost benefitCost utility

Assay performance

SensitivitySpecificityReproducibilitySupplemental testingQuality assuranceTurnaround time

InstrumentationThroughputsFacilities personnel

Selective screening presumptive treatment

Specimen collectionPredictive valuesSpecimen typeSymptomsgender

Cost

Testing costsNon testing cost

Epidemiology

PrevalenceClinical settingRisk indicators:DemographicBehavioral and clinical variables

Consideration for appropriate selection and use of laboratory tests. From Pfister. Reprinted with permission of the university of Wisconsin Board of Regents

References

WHO. Asia pacific strategy for strengthening health lab. Services (2010-2015).

A. Robinson. Rationale foe cost effective lab. Medicine. Clin Microbiol.Rev. 1994:185-199.

N. Shatnawi, W. Hayienh , others. The role of clinical practice guidelines in reducing lab. Health care expenditure in developing country. J app Sc 2008. 8(19): 3508-3512.

Occupational Outlook handbook , 2010-11, Edition. http://www.bls.gov/oco/home.htm

Special thanks

Conference OrganizersOur Lab Staff

Audience