CLINICAL LAB SCIENEC

162
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
Critical Reminder
Traits and Activities That Lead
to the Need for Increased
Health Care Services
• Genetic predisposition for
certain diseases
• Sedentary lifestyle
• Smoking
• Excessive drinking of alcohol
• Poor diet
• Obesity
• Practicing dangerous
activities
• Risky lifestyle—
drugs and sex
percentagewise on an annual basis? Many taxpayers and health care
consumers emphatically voice a “No!” response to this question.
Some companies are hiring only nonsmokers in return for lower
health insurance premiums that are offered by companies who have a
pool of employees who practice a health-conscious lifestyle. It is legal for
companies to hire only nonsmokers and refuse to pay for medical treatment
for smoking-related illnesses, or to fire workers who have signed a
pledge that they do not smoke but then begin smoking.
Given the rapidly rising health costs for which employers share at
least part of the burden of coverage, it is probable that more companies
will place restrictions on those who work for them. Most causes of type 2
diabetes can be actually reversed or cured by weight loss. Hypertension
may be caused by smoking and, along with obesity, contributes greatly
to heart disease and to an increased risk of cancer. Some employers are
supplying workout areas in their companies as well as restricting vending
machines to low-fat foods that have little or no processed sugars or
white flour in them, both of which are culpable in weight gains leading to
obesity. Some insurers now charge a surcharge for employees who smoke
and for those who refuse to adopt a healthier lifestyle. So far there has
been no legal decision that would prevent such practices by the insurance
companies and employers.
Laboratory-Specific Economics
In a similar manner to that of the health care providers who have either chosen
or have been pressured to be cost conscious, the laboratory has been pushed to
control costs. Many insurance companies, as well as Medicare and Medicaid,
reimburse for laboratory services at a much lower rate than the costs associated
with performing the tests. As in the hospital, low levels of reimbursement lead
to higher costs for other tests to make up the difference. Contractual arrangements
are also made by laboratories to garner a large amount of procedures
that can be performed in bulk at a much lower cost than if only lower volumes
of individual tests are ordered. This is the idea behind “panels” of tests, which
began in the 1960s. Panels for high levels of fats in the blood, kidney disease,
heart disease, anemia, endocrine problems, and many others were developed to
cover a wide array of tests that led to a quick and definitive diagnosis of specific
ailments in most cases. These panels are much cheaper than running each test
individually. They provide multiple test results where one test may confirm the
results of another or may indicate that additional tests may be necessary for
confirming a diagnosis.
The basic role of the laboratory is to provide diagnostic test results to aid
in the evaluation of patients for both diagnosis and prognosis. But to hospital
administrators (CEOs and assistants), the laboratory may also be viewed
as a “cost center” along with radiography, pharmaceutical services, respiratory
therapy, and certain other departments—providing critical sources of funding
for the entire hospital. Laboratory revenues may be used to cover the costs of
operation of the laboratory, such as overhead, employees and benefits, costs of
equipment and supplies, and licensure and accreditation fees. In addition, the
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