Cost of carrying out clinical diagnostic tests

The total cost of performing diagnostic tests in a hospital laboratory during one year was assessed. The largest single item of expenditure was the cost of the salaries of the technical staff, while the cost of reagents (including radiopharmaceuticals) was relatively small. The total costs of carrying out diagnostic tests are much higher than is often recognised by those who request them. The use of relatively expensive, commercially available assay kits saves time and gives good value for money. It may be worth taking this into account when planning hospital budgets.

An approach to cost analysis of clinical laboratory services

The authors have developed a system that provides information about costs related to specific laboratory tests. These costs are derived from: (1) labor and material actually used for specific tests; (2) allocation of costs for labor and material shared by several different tests; (3) allocation of supervisory and management costs. The "cost" of a specific procedure is a theoretical construct that is significantly affected by the method chosen for allocation. We know of no cost-analysis system generally accepted by all clinical laboratories. Since third-party payers may base future reimbursement on costs rather than charges, accurate systems for clinical laboratory cost analysis may have some practical value.

Primary laboratory medicine

A list of laboratory tests which should be available in a primary care facility is presented. The primary physician should be able to perform or obtain reports of blood smears, urinalysis, hematocrit, white blood counts, sedimentation and prothrombin information during the patient's visit. In general, those tests that are not practical to perform include those that are seldom used, that require extended time for performance, that are complicated and require special technical skills and that demand expensive and elaborate equipment and unstable expensive reagents. Equipment recommended for a primary laboratory is also listed. Tests to be run on each individual patient should be selected carefully because of the cost factor as there are limited financial resources for health care delivery.

Paying for diagnostic accuracy

One of the difficult problems facing managers is how to evaluate the benefits to be gained from introducing a new diagnostic test that may be more accurate--but also more expensive. What analyses can be applied to help the hospital make the choice to switch or not?