CLINICAL LAB SCIENEC

CHAPTER 7: MEDICAL ECONOMICS AND LABORATORY EQUIPMENT 167
These screening tests must have the specificity (sometimes called validity) for
“picking up” diagnostic findings on patients who are either diseased or at risk
for becoming so. Specificity is defined as a test measuring what it is intended to
measure, with little or no interference from other materials, and providing a true
or specific value. Optimally, a test must be specific enough that it does not yield
a positive result for other materials in the body (cross-reactive) but possesses the
sensitivity to pick up low levels of constituents for which the test is being used.
Sensitivity should not be so high that normal patients will show erroneous positive
results. Sensitivity of diagnostic testing indicates that the test is designed to
detect clinically significant levels of a constituent of the blood, as an example,
by its ability to pick up positives on minute amounts if necessary. But it should
not be too sensitive in that some tests will give a false positive in patients with
values for constituents of the blood or other body fluids that are normally found
at low levels in the body.
Contracts for Services, Equipment, and Supplies
Contracts in general are promulgated for the convenience and advantage of both
the provider and the consumer. It is to the advantage of the manufacturer to capture
a large account from which the institution will order all of its reagents and
control specimens for calibrating and operating its equipment. Another large
category included in many contracts is that of consumable supplies that are used
in large quantities. Bids may be sought by entire government agencies such as the
Veterans’ Administration for its hospitals, or by large health care systems that
may include a number of hospitals or clinics.
Since the institutions under contract are barred from buying from other companies,
the contracting company can afford to sell in quantity at much lower
prices to large-volume customers than if a large number of smaller institutions
were each buying at lower levels. Sometimes an advantage of these contracts may
lie in the ability of the manufacturer to deliver supplies and equipment to one
central warehouse, where the health care system itself assumes the responsibility
and expense of distributing the items to its various offices and facilities. Billing
for the large numbers of materials purchased under contract greatly simplifies the
process of payment. Because the manufacturer may also have an estimate of the
level of certain items that will be needed on an annual basis, the manufacturer is
able to produce large quantities quickly and store them for distribution as they
are ordered.
Lease-Purchase Agreements
Many sophisticated pieces of laboratory equipment are extremely expensive to purchase
and to maintain. Most manufacturers have arrangements by which a health
care facility may use the equipment for as long as the laboratory will purchase supplies
and reagents for that piece of equipment. Technology is also evolving at such
a rate that often what is new today is outmoded tomorrow. Many pieces of laboratory
testing equipment are outdated within 2 to 3 years. Creative arrangements are
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