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Salwa Alansari - clinical biochemistry department

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  • 1. Laboratory tests: a time for cutting off costs!
    Dr. salwa Al-ansari
    Clinical biochemistry department
    Jaber al- ahmad armed forces hospital, Ministry of defense: kuwait
  • 2. Introduction:
    Health care services
    1- Preventive
    • Surveillances and epidemiology
    • 3. Diseases control &prevention
  • 2- Mother r & Child
  • 3- Primary health services
    Patient’s Every day health services:
    • Medical practitioner
    • 6. Assistant health services
  • Assistant health services
    • X- ray
    • 7. Physiotherapy
    • 8. Pharmacy
    • 9. Clinical Laboratory
    • 10. Ambulance & Paramedics …etc
  • Clinical Laboratories:
    • Clinical Biochemistry
    • 11. Hematology
    • 12. Microbiology(incl. serology & Parasitology)
    • 13. Histopathology
  • Laboratory service providers:
    Hospital based lab.
    Physician based lab
    Independent clinical lab
  • 14. Specialty:
    Surgical specimen
    blood transfusion and coagulation
    CBC
    Allergy
    Acute phase reactants
  • 15. Full biochemical profile
    Hormones
    Tumor markers
    Trace elements & Vitamins
    Cultures
    Urine routine
    Semen analysis
    …….etc
  • 16. Laboratory Tests:
  • Statistics: Depends?
    • Billions of tests yearly!
    • 20. Important for patients!
    • 21. Where is the problem ?
    • 22. Not needed
    • 23. Too often
    • 24. Leads to more procedures
    • 25. False +ve results
  • 24 hours working plan
    Increased number of ordered tests
    ↑↑Pressure on the lab
    More staffmore reagents
    ↑↑laboratory budget & Cost of service
  • 26. “WHO”: Many health systems are underfunded and even the well–
    funded ones are under economic pressure due to increasing demand and cost inflation. In these scenarios, laboratory services are often accorded low priority
    and inadequate allocation of “resources.
  • 27. ≈ 70% of health decisions involving laboratory results
    >10 % total hospital admission tests.
    ≈ lab cost 24 % hospital bill
  • 28. Increased # tests? Is it crucial?
    Responsibility??
    • 80 % clinicians
    • 29. Patients
  • Cost of a test:
    1- Variable:
    • Operating expenses & reagnets
    • 33. Stat testing
    • 34. Salaries
    • 35. troubleshooting
    • Replacement parts
    • 36. Re-running controls & specimens
    • 37. Overtime?
    • 38. Delayed results ->-> ↑↑length of stay
  • 2- Fixed:
  • Costs:/ Kuwait
    Ministry health :3rd largest public sector employer.
    Total expenditure on Health: 6.7 % budget (2002-2003).
  • 42. Non profit community hospital
    Average biochemical routine tests cost 3-10 k.D
    Special tests 2.5-321.5 k .D
  • 43.
    • 10% of tests results left uncollected!
    • 44. Tests re- 0rdered again after couple of weeks
    • 45. Extra –tests added
  • j. A. A.F.H capacity ≈ 200 beds
    Average samples 15359 / month.
    clin. Biochemist. :an attempt to ↓ unnecessary test during October 2010.
  • 46. Total lab. Tests number was average
    but:
    Biochemical tests ↑ 121 %. Calculate the cost?
    Was is it necessary????
  • 47. 10/08 8/08 5/08 6/0812/08 6/08 4/08 1/09 3/09 5/09 4/09 10/09 1/10 3/10 4/10 5/10 6/10 8/10 10/10
    Number of tests carried out during specified months (2008-2010)
  • 48. October 2010
    Number of tests for clinical biochemist. Depart. During October 2008-2010
  • 49. Still too many results not collected
    • Why? !
    • 50. Any effect on service quality?
    • 51. Are there any corrective measures?
  • Our step:
    • Single central
    • 52. Very. Small
    • 53. Limited duration
  • What we need ?
    • Inform the patients and clinicians cost of each test.
    • 54. Cost analysis study “experience studies”.
    • 55. Establish lab ethics & roles
    • Share information: clinicians (causality ,outpatients) & lab.
    • 56. Physicians education programs
    • 57. Government price control .
    • National Standardization
    • 58. Correct the implemented decentralization, privatization and commercialization
    • Strengthen laboratories to provide critical inputs in making informed decisions
    • 59. Multiple strategies & communications.
    • 60. Changing the Disease specific lab.
  • Financing
    Improved health (level & quality)
    Health Workforce
    Access
    Coverage
    Responsiveness
    Information
    Social financial risk protection
    Medical products & technologies
    Quality
    Safety
    Improved efficiency
    Service delivery
    Leadership/Governance
    WHO Health system Framework; Geneva, WHO , 2007
  • 61. Assay performance
    Sensitivity
    Specificity
    Reproducibility
    Supplemental testing
    Quality assurance
    Turnaround time
    Specimen collection
    Predictive values
    Specimen type
    Symptoms
    gender
    Instrumentation
    Throughputs
    Facilities
    personnel
    Cost effectiveness
    Cost benefit
    Cost utility
    Epidemiology
    Prevalence
    Clinical setting
    Risk indicators:
    Demographic
    Behavioral and clinical variables
    Cost
    Testing costs
    Non testing cost
    Selective screening presumptive treatment
    Consideration for appropriate selection and use of laboratory tests. From Pfister. Reprinted with permission of the university of Wisconsin Board of Regents
  • 62. References
    • WHO. Asia pacific strategy for strengthening health lab. Services (2010-2015).
    • 63. A. Robinson. Rationale foe cost effective lab. Medicine. Clin Microbiol.Rev. 1994:185-199.
    • N. Shatnawi, W. Hayienh , others. The role of clinical practice guidelines in reducing lab. Health care expenditure in developing country. J app Sc 2008. 8(19): 3508-3512.
    • 64. Occupational Outlook handbook , 2010-11, Edition. http://www.bls.gov/oco/home.htm
  • Special thanks
    Conference Organizers
    Our Lab Staff
    Audience