984-Cost Effective Microbiology

Course # DL-984: Cost Effective Clinical Microbiology

by James I. Mangels, MA, CLS, MT(ASCP) - Consultant - Microbiology Consulting Services Santa Rosa, CA

Approved for 3.0 CE
Level of Difficulty: Intermediate


It has been well known for some time that the United States spends more per capita on health care than other countries despite the spread of managed care, other changes to health care, such as the Patient Protection and Affordable Care Act, or “Obamacare”, overall health care expenditures in the U.S. continue to increase to record levels. What may be less well know is that the United States has had one of the highest increases in per capita health care spending since 1980 among higher income countries. While spending more on health care, Americans had poorer health outcomes, shorter life expectancy and greater prevalence of chronic conditions compared to other higher income countries (1). Health care spending around the world generally is rising at a faster rate than overall economic growth, so almost all countries have seen health care spending increases as a percentage of their gross domestic product (GDP). In the United States, which has had both a high level of health spending per capita and a relatively high rate of real growth, the share of GDP devoted to health care grew from 8.8% of GDP in 1980 to 17.5% in 2015 (1). This 8.7% increase in health share of GDP is larger than increases seen in other high-income countries. See Table 1. Total U.S. spending for health care was $2.16 trillion in 2006, or $7,110 per person, whereas, U.S. spending grew to $3.0 trillion in 2015 or $9,523 per person. The Centers for Medicare and Medicaid Services (CMS) has projected U.S. health care expenditures to grow at an average rate of 5.8% from 2015 to 2020 to reach 20% of GDP or $4.6 trillion. Per person health spending is projected to increase to $13,708 by the end of that period (1).

There are a variety of reasons for the current state of high health care costs in the United States (2, 3). Whether one attributes the high costs to waste and inefficiency, inflated prices, poor management, inappropriate care, or over-consumption, the cost is too high. Many economists and health policy analysts argue that new medical technology (new drugs, devices, treatments, and techniques) is responsible for a substantial portion of the growth in health expenditures. The cost of health care has exceeded what the public is willing to pay, especially in view of the growing realization or perception that increased expenditures have only marginally improved the health in our country. See Table 1, “U.S. Health Care Facts.”

This distance learning course addresses one specific aspect of health care spending: clinical microbiology laboratory tests and the costs associated with them. This course explains how clinical microbiology laboratory costs affect patients, institutions, and the health care system, and offers suggestions for how we in the clinical microbiology laboratory can reduce our costs.


After completing this course the participant will be able to

1. Discuss the role of laboratory expenditures in the cost of health care.

2. Outline the history of cost-based reimbursement during the fee-for-service era.

3. Explain how the laboratory can control cost.

4. Outline methods to control cost in the microbiology laboratory.

5. Explain laboratory technical operation methods to control cost.

6. State obstacles and methods to deal with test ordering practices.

7. Identify the laboratory management operations methods to help control cost.

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