CHANGES IN THE AMERICAN HEALTH-CARE SYSTEM - CRISIS IN THE CLINICAL LABORATORY

American medicine is undergoing unprecedented changes, and the resulti ng distortions are affecting the economics, organization and operation s of all clinical laboratories. Professionals who work in these labora tories are facing administrative and economic pressures to reduce cost s, to increase productivity, and to comply with proliferating new stat utes and regulations. The medical 'cottage industry' in which the pati ent was the focus of the medical professionals' attention and endeavou rs is being replaced by the corporate management of many health care a ctivities in which financial profits are being given first priority. M edical facilities, including clinical laboratories, are being bought a nd sold, being consolidated, or simply being closed. The clinical labo ratories may be at the vortex of the maelstrom affecting American medi cine. Cost pressures are encouraging further automation and retraining of laboratory staffs. If the leaders in laboratory medicine are unabl e to accomplish the necessary tasks to meet the new challenges, there inevitably is a non-medical, non-scientific financial manager at hand who is willing to define the changes and the desired outcome. Because of the rapidity of the changes taking place, it is not possible to pre dict with any confidence the modifications that will achieve a permane nt status or the degree to which medical professionals will remain mas ters of their fates. The evolving health care system will become less costly, more technologically advanced, and a more challenging system i n which to work. (C) 1997 Elsevier Science B.V.