THE EFFECT OF REMOVAL OF PROFILE REQUESTING ON CHEMICAL PATHOLOGY REQUESTING PATTERNS

We investigated the effect on pathology requesting behaviour in a metr opolitan teaching hospital, following the proscription by the Health I nsurance Commission of the MBA (multiple biochemical analysis) request . Our laboratory had provided a 20 test profile in response to a reque st for MBA until February 1991, when the MBA request was no longer acc epted. During the period February to June 1991, requesting clinicians had to comply with the new requesting requirements, although they cont inued to receive the results of the 20 test profile because of limitat ions imposed by our laboratory instrumentation. After June 1991, with the installation of a new analyzer that allowed discretionary requesti ng, results were provided only for those tests requested. We studied r equesting patterns in the 3 time periods: i.e. (1) before the MBA requ est was withdrawn, and after the MBA request was withdrawn, (2) firstl y while results for the 20 test profile were still provided and (3) se condly when the results were provided only for the tests requested. Fo r each of the 3 periods the average number of requests per day for MBA , group and individual tests was calculated. The effect of removal of the MBA request on the Medicare Benefits payable was estimated. We fou nd compliance by the requesting clinicians with the new requirements a nd a reduction in the number of tests requested. There was a reduction from 20 to 12 in the average number of tests per request. This was as sociated with a 2.2% reduction in the Medicare Benefits payable.