salwa alansari - clinical biochemistry department
TRANSCRIPT
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