Sei sulla pagina 1di 10

Introduction

Medical Laboratories and


the Public-Private Debate
,¿UVWEHFDPHDZDUHWKDWVRPHWKLQJZDVVHULRXVO\ZURQJLQRXUPHGLFDOODERUD
WRU\V\VWHPLQWKHVZKLOHZRUNLQJDVDKRPHFDUHQXUVHLQHDVWHUQ2QWDULR
,ZDVSDUWRIDWHDPDGPLQLVWHULQJLQWUDYHQRXVDQWLELRWLFVLQSDWLHQWV¶KRPHV
2FFDVLRQDOO\ D SDWLHQW H[KLELWHG GDQJHURXV V\PSWRPV WKDW PLJKW KDYH EHHQ
DUHDFWLRQWRWKHGUXJLQWKHVHFDVHVDSURPSWDQDO\VLVRIEORRGOHYHOVRIWKH
GUXJZDVUHTXLUHG0'6DIRUSUR¿WPXOWLQDWLRQDOKHDOWKFDUHFRUSRUDWLRQKDG
EHHQDZDUGHGWKHFRQWUDFWWRSURYLGHODERUDWRU\VHUYLFHVWRKRPHFDUHSDWLHQWV
LQ .LQJVWRQ EXW XVLQJ 0'6 PHDQW VHQGLQJ WKH EORRG VDPSOH WR 7RURQWR IRU
DQDO\VLV 6RPH RI WKHVH WHVWV DUH XQFRPPRQ DQG RIWHQ ZH ZRXOG QRW JHW D
UHVXOWIRUDIHZGD\V7KLVZDVXQDFFHSWDEOH:HKDGWRNQRZZKHWKHURUQRWLW
ZDVVDIHWRJLYHWKHQH[WGRVHODWHUWKDWGD\6RZHVLPSO\VHQWWKHEORRGWRWKH
ORFDOKRVSLWDOODERUDWRU\ZKHUHSURFHVVLQJZDVGRQHTXLFNO\DQGUHVXOWVZHUH
LPPHGLDWHO\DYDLODEOH
 8QIRUWXQDWHO\ EHFDXVH RI JRYHUQPHQW SROLF\ WKH KRVSLWDO UHFHLYHG QR
PRQH\IRUSURYLGLQJWKLVFOHDUO\VXSHULRUVHUYLFH,QVWHDGWKHVHUYLFHZDVSDLG
IRURXWRILWVJHQHUDORSHUDWLQJEXGJHWUHGXFLQJWKHIXQGVDYDLODEOHIRURWKHU
LQKRVSLWDOVHUYLFHV 0'6ZDVXQKDSS\EHFDXVHZHZHUHWDNLQJOXFUDWLYHIHH
IRUVHUYLFHZRUNDZD\IURPWKHP7KHKRPHFDUHDJHQF\WKH&RPPXQLW\&DUH
$FFHVV&HQWUHZDVXQKDSS\EHFDXVHZHZHUHEUHDNLQJWKHUXOHVDQGLQRXURZQ
VPDOOZD\VDERWDJLQJWKHIRUSUR¿WGHOLYHU\RIKHDOWKVHUYLFHV%XWWKHQXUVHV
SDWLHQWVDQGGRFWRUVZHUHKDSS\EHFDXVHZHJRWWKHUHVXOWVZHQHHGHGZKHQZH
QHHGHGWKHP
 /DERUDWRULHVDUHFHQWUDOWRWKHSUDFWLFHRIPDLQVWUHDPPHGLFLQHLQ&DQDGD
7KH\SOD\DUROHLQSHUFHQWRIPHGLFDOGLDJQRVHV0RVW&DQDGLDQVKDYHKDG
DWOHDVWRQHLQWLPDWHUHODWLRQVKLSZLWKDPHGLFDOODERUDWRU\LQWKHLUOLIHWLPH
SUREDEO\PDQ\PRUH1HZERUQEDELHVKDYHPDQGDWRU\EORRGWHVWVFKLOGUHQ
KDYHWKHLUWKURDWVVZDEEHGKHDOWK\DGXOWVKDYHVWRRODQGEORRGVFUHHQLQJ
DQGDQ\RQHZLWKDVLJQL¿FDQWLOOQHVVKDVERGLO\ÀXLGVDQGRUWLVVXHVDPSOHV
DQDO\]HG,QHDFKLQVWDQFHDZURQJODERUDWRU\UHVXOWFDQKDYHGLUHFRQVH
TXHQFHV
 7KHODVWGHFDGHKDVVHHQDVHULHVRIVFDQGDOVLQYROYLQJWKHLQFRUUHFWLQWHU
SUHWDWLRQRIZRPHQ¶VSDWKRORJ\WHVWVDODERUDWRU\WHVWWRLGHQWLI\DEQRUPDOLWLHV
LQFHOOV7KHUHVXOWVZHUHPLVVHGEUHDVWFDQFHUGLDJQRVHVDQGLQFRUUHFWO\LGHQWL
¿HGFDQFHUV7KHVHODERUDWRU\HUURUVFDXVHGPDQ\ZRPHQWRUHFHLYHGDQJHURXV
WUHDWPHQWVWKH\GLGQRWQHHGDQGPDQ\RWKHUVWREHGHQLHGOLIHVDYLQJWUHDWPHQW

9
10 False Positive

WKH\GLGQHHG0DQ\RIWKHZRPHQDIIHFWHGGLGQRWOLYHORQJHQRXJKWRUHFHLYH
WKHFRPSHQVDWLRQDQGDSRORJLHVWKH\GHVHUYHG
 7KHVHWUDJLFFDVHVLOOXVWUDWHKRZLPSRUWDQWODERUDWRU\WHVWLQJLV$QLQFRUUHFW
GUXJVFUHHQLQJWHVWFDQFRVWDZRUNHUWKHLUMRE$PLVODEHOOHGEORRGVDPSOHFRXOG
UHVXOWLQWKHDGPLQLVWUDWLRQRIEORRGWKLQQHUVWRWKHZURQJSDWLHQWLQFUHDVLQJWKH
ULVNRIDVWURNH$QLPSURSHUO\FROOHFWHGRUVWRUHGEDFWHULDOFXOWXUHFDQUHVXOWLQ
DQHIIHFWLYHDQWLELRWLFWUHDWPHQWEHLQJGHOD\HG)DLOXUHWRFROOHFWZDWHUVDPSOHV
SURSHUO\RUUHSRUWUHVXOWVDVKDSSHQHGLQ:DONHUWRQ2QWDULRFDQUHVXOWLQVHUL
RXVKDUPWRWKRXVDQGVRISHRSOH<HWODEVWHQGWRUHFHLYHRQO\SDVVLQJPHQWLRQ
LQGLVFXVVLRQVRIRXUKHDOWKFDUHV\VWHP
 7KDWWKHODERUDWRU\VHFWRUPDLQWDLQVDORZSUR¿OHLVDOOWKHPRUHVXUSULVLQJ
JLYHQWKHFHQWUDOLW\RIWKHVHUYLFHVLWSURYLGHV/DERUDWRU\ZRUNHUVFRPSULVH
WKHWKLUGODUJHVWJURXSRIKHDOWKFDUHSURIHVVLRQDOVDQGPHGLFDOODERUDWRULHV
FRQVXPHRYHUELOOLRQRISXEOLFPRQH\HYHU\\HDU/DERUDWRU\VHUYLFHVKDYH
EHHQFDOOHGWKHWRXFKVWRQHRIPRGHUQPHGLFDOSUDFWLFH/DERUDWRU\UHVXOWVDUH
NH\WRPHGLFDODXWKRULW\DQGIRXQGDWLRQDOWRPHGLFLQH¶VHYROXWLRQ
 $QGODEVDUHQRWVWUDQJHUVWRFRQWURYHUV\7KHUHDUHUHJXODUDFFXVDWLRQV
RI IUDXG RYHU XVH H[FHVVLYH FRVW DQG PHGLFDO PLVFRQGXFW OHYHOOHG DJDLQVW
ODERUDWRULHVEXWJHQHUDOO\VSHDNLQJZKDWKDSSHQVWRRXUEORRGVSXWXPVWRRO
RUWLVVXHVDPSOHVDIWHUWKH\OHDYHRXUERGLHVGRHVQRWFRQFHUQXV/DERUDWRU\
VHUYLFHVDUHDFFHSWHGDVDQLQWHJUDO\HWKLGGHQSDUWRIRXUKHDOWKFDUHV\VWHP
0RVWSHRSOHJLYHOLWWOHWKRXJKWWRZKRRZQVWKHODEVKRZWKHLUVHUYLFHVDUHSDLG
IRUKRZWKH\DUHRUJDQL]HGRUKRZWKHGHOLYHU\RIWKHVHVHUYLFHVDIIHFWVRXU
SXEOLFKHDOWKFDUHV\VWHP7KHVHVHUYLFHVDUHXQLTXHDPRQJWKHNH\HOHPHQWV
RIRXUSXEOLFDFXWHFDUHV\VWHPLQWKDWIRUSUR¿WPXOWLQDWLRQDOFRUSRUDWLRQVSOD\
DFHQWUDOUROHLQWKHLUGHOLYHU\
 :KLOHODUJHO\XQQRWLFHGIRUSUR¿WPHGLFDOODERUDWRULHVKDYHQRWEHHQDEVHQW
IURPWKHGHEDWHRQWKHIXWXUHRIPHGLFDUH7KHLUH[LVWHQFHKDVEHHQXVHGWRDUJXH
WKDWJUHDWHUSULYDWHLQYROYHPHQWLQRXUKHDOWKFDUHV\VWHPLVPRUHHI¿FLHQWDQG
HIIHFWLYHWKDQUHO\LQJRQQRQSUR¿WSXEOLFVHUYLFHV&RQWUDU\WRWKHVHDUJXPHQWV
ZKLFKDUHGULYHQE\DQDLYHEHOLHILQWKHVXSHULRULW\RIPDUNHWVDQGWKHSUR¿W
PRWLYHWKLVERRNVKRZVWKDWLQWKHFDVHRI&DQDGD¶VPHGLFDOODERUDWRU\VHUYLFHV
WKHH[FOXVLYHXVHRISXEOLFQRQSUR¿WRUJDQL]DWLRQVZRXOGEHWKHEHVWZD\WR
LQFUHDVHDFFHVVFRQWUROFRVWVLQWHJUDWHVHUYLFHVLPSURYHTXDOLW\DQGHQKDQFH
WKHGHPRFUDWLFFRQWURORIKHDOWKFDUH

The Public-Private Debate


2QHRIWKHFHQWUDOSROLF\GHEDWHVLQ&DQDGDLVRYHUWKHIXWXUHRIXQLYHUVDOKHDOWK
FDUHIRUPHGLFDOO\QHFHVVDU\VHUYLFHV$OWKRXJKPHGLFDUHFRQWLQXHVWRHQMR\
HQRUPRXVSRSXODUVXSSRUW ,3626 DVLWKDVVLQFHLWVLQFHSWLRQLWLVXQGHU
DWWDFN7KLVLVQRWVXUSULVLQJ+HDOWKFDUHLQ&DQDGDLVELJEXVLQHVVDVLWLVLQ
PRVW DGYDQFHG FDSLWDOLVW FRXQWULHV &DQDGD¶V WRWDO \HDUO\ SXEOLF H[SHQGLWXUH
RQKHDOWKFDUHLVDSSUR[LPDWHO\ELOOLRQLWDFFRXQWVIRURYHUSHUFHQWRI
2QWDULRSURJUDPVSHQGLQJ5REHUW(YDQVZULWLQJLQFRPPHQWHGWRQJXH
Medical Laboratories and the Public-Private Debate 11

LQFKHHN³WKHUHKDVDOZD\VEHHQDFULVLVLQ&DQDGLDQKHDOWKFDUH´  DQG
WKHUHDVRQVDUHDOZD\VWKHVDPHFXWEDFNVVKRUWDJHVDQGVSLUDOOLQJFRVWV7KH
PDLQSHUSHWUDWRUVRIWKLVFULVLVUKHWRULFFRQWLQXHWREHWKRVHZKRZLVKWRORZHU
WKHFRVWVWRWKH³ZHDOWK\DQGKHDOWK\´DQGLQFUHDVHWKHEHQH¿WVWRWKHIRUSUR¿W
KHDOWKFDUHFRUSRUDWLRQV
 7KHVHWKUHDWVWRRXUSXEOLFKHDOWKFDUHV\VWHPDUHEHLQJFKDOOHQJHGE\D
EURDGEDVHGFRDOLWLRQRIFRPPXQLW\DQGODERXURUJDQL]DWLRQVZKRVHPHPEHUV
DUJXHWKDWRXUFXUUHQWV\VWHPLVVXVWDLQDEOHSURYLGHVVHFXULW\IRUFLWL]HQVDQG
HPERGLHVZKDWLVEHVWDERXWVRFLDOUHIRUPLWLVLQFOXVLYHDQGFROOHFWLYHDQGLW
SODFHVQHHGEHIRUHDELOLW\WRSD\8QLYHUVDOKHDOWKFDUHLVHVVHQWLDOWRDIXQFWLRQ
LQJGHPRFUDF\ /H\V 
 :KLOHWKHPDLQLVVXHLQWKHVHGHEDWHVLVRIWHQXQLYHUVDOSXEOLFLQVXUDQFH
IRUHVVHQWLDOKHDOWKFDUHVHUYLFHVWKHTXHVWLRQDV5REHUW(YDQV  QRWHVLV
UHDOO\FORVHGPRVWREVHUYHUVLQKHDOWKSROLF\DQGSROLWLFDOFLUFOHVDJUHHPHGLFDUH
LVPRUHFRVWHIIHFWLYHDQGHI¿FLHQWWKDQWKHDOWHUQDWLYHV(YHQLGHRORJLFDOIUHH
PDUNHWVXSSRUWHUVVXFKDV3ULPH0LQLVWHU6WHYHQ+DUSHUKDYHVWRSSHGGLUHFWO\
DWWDFNLQJXQLYHUVDOKHDOWKLQVXUDQFH
 7KHUHLVOHVVXQDQLPLW\RQWKHTXHVWLRQRISULYDWHGHOLYHU\3ULYDWHFRUSRUDWH
LQWHUHVWVKDYHLQFUHDVHGWKHLUSUHVVXUHIRUPRUHIRUSUR¿WFOLQLFVWRSURYLGHD
YDULHW\RIVHUYLFHV 05,VDQG &7VFDQVFDWDUDFWVXUJHULHVMRLQWUHSODFHPHQWV
IDPLO\PHGLFDOVHUYLFHVKRPHFDUHDQGWKHFRQVWUXFWLRQDQGRSHUDWLRQRIKRV
SLWDOV$UPLQH<DOQL]\DQ  LGHQWL¿HVWKHJURZLQJXVHRISXEOLFIXQGVWR
SD\IRUSULYDWHIRUSUR¿WGHOLYHU\RIVHUYLFHVDVRQHRIWKHIRXUPDLQWKUHDWVWR
WKHVXVWDLQDELOLW\RI&DQDGD¶VSXEOLFKHDOWKFDUHV\VWHP
 7KHKLVWRU\RIWKHGHYHORSPHQWRIPHGLFDOODERUDWRU\VHUYLFHVLQ&DQDGD
JRHVWRWKHKHDUWRIWKHGHEDWHRQWKHSULYDWHGHOLYHU\RISXEOLFO\LQVXUHGPHGL
FDOVHUYLFHV,QPHGLFDOODERUDWRULHVZHKDYHDIRUW\\HDUFDVHVWXG\RQWKHXVH
RIIRUSUR¿WFRPSDQLHVWRSURYLGHDQHVVHQWLDOPHGLFDOVHUYLFH7KHUHVXOWVDUH
FOHDUWKHVHFRPSDQLHVDUHPRUHH[SHQVLYHDQGWKH\KDYHIRXJKWLQWHJUDWLRQ
XQGHUFXWGHPRFUDF\DQGQHJDWLYHO\LPSDFWHGDFFHVVDQGTXDOLW\LQRXUKHDOWK
FDUHV\VWHP7KH\DUHDWKUHDWWRWKHVXVWDLQDELOLW\RIXQLYHUVDOKHDOWKFDUH
 $VWXG\RI&DQDGD¶VFRPPXQLW\ODERUDWRU\VHUYLFHVSURYLGHVDFRPSDULVRQ
EHWZHHQQRQSUR¿WLQVWLWXWLRQVDQGSULYDWHFRUSRUDWLRQVLQWKHGHOLYHU\RIWKH
VDPHVHUYLFH7KHHYROXWLRQRIFRPPXQLW\ODERUDWRU\VHUYLFHVLVWKHVWRU\RI
WKH GHYHORSPHQW RI WKUHH PXOWLQDWLRQDO KHDOWK VHUYLFH FRUSRUDWLRQV ² 0'6
/LIH/DEV &0/ DQG '\QDFDUH ² DQG WKH LQWHQWLRQDO XQGHUPLQLQJ RI SXEOLF
QRQSUR¿WODERUDWRU\VHUYLFHV
 7KLVDQDO\VLVWDNHVVHULRXVO\&ROLQ/H\V¶DGPRQLWLRQ³WKHLPSDFWVRIHFR
QRPLFIRUFHVQHHGWREHVWXGLHGQRWRQO\DWWKHOHYHORISROLWLFVLQJHQHUDOEXW
DOVRLQVSHFL¿FPDUNHWV´  LQWKLVFDVHWKHSXEOLFPDUNHWIRUPHGLFDO
ODERUDWRU\VHUYLFHV
 0HGLFDO ODERUDWRULHV VWDUWHG DV QRQSUR¿W IDFLOLWLHV LQ RXU SXEOLF KHDOWK
VHUYLFHVDQGWKHSXEOLFKRVSLWDOV\VWHP$IWHUWKHLQWURGXFWLRQRIPHGLFDUHLQ
 IRUSUR¿W ODERUDWRU\ FRUSRUDWLRQV H[SDQGHG UDSLGO\ LQ ¿YH SURYLQFHV
12 False Positive

*RYHUQPHQWSROLFLHVFUHDWHGDPDUNHWIRUWKHLUVHUYLFHVSXEOLFPRQH\IXQGHG
WKHLU JURZWK DQG LQVWLWXWLRQV ZHUH HVWDEOLVKHG WR FRQVROLGDWH WKHLU SROLWLFDO
SRZHU*RYHUQPHQWSROLF\LQIDYRXURIWKHJUHDWHUXVHRISULYDWHODERUDWRULHV
ZDVVWURQJO\VXSSRUWHGE\DFWLRQVRIWKHPHGLFDOSURIHVVLRQ
 7KHVWUXFWXUHRI&DQDGLDQIHGHUDOLVPSURYLGHVDQDWLRQDODQGSURYLQFLDO
FRQWH[WIRUH[SORULQJWKHVSHFL¿FLPSDFWVRIFKDQJHVLQJOREDOFDSLWDOLVPRQ
&DQDGD¶VFRPPXQLW\ODERUDWRU\VHUYLFHV7KHVKLIWWRDPRUHFRUSRUDWHODERUD
WRU\VHUYLFHSDUDOOHOHGWKHGHYHORSPHQWRIJOREDOFDSLWDOPDUNHWVDQGWKHULVHRI
QHROLEHUDOLVPDVDSROLWLFDOSURMHFWWRXQGHUFXWFROOHFWLYHVHUYLFHVVXFKDVKHDOWK
FDUHDQGLQFUHDVHRSSRUWXQLWLHVIRUSULYDWHSUR¿W7KHSXEOLFO\IXQGHGGHYHO
RSPHQWRIFRPPHUFLDOODERUDWRULHVKDVDOVRLQFUHDVHGLQWHUQDWLRQDOHFRQRPLF
LQWHJUDWLRQE\ERWKIDFLOLWDWLQJWKHH[SDQVLRQRI&DQDGLDQFRPSDQLHVRQWRWKH
LQWHUQDWLRQDOVWDJHDQGDOORZLQJ$PHULFDQFDSLWDOWREX\LQWR&DQDGD

What Is Public and What Is Private?


'LVFXVVLRQRIWKHXVHRISULYDWHFRUSRUDWLRQVLVPDGHPRUHGLI¿FXOWERWKE\
WHUPLQRORJ\DQG E\ WKHUHDOLW\RI WKH&DQDGLDQKHDOWKFDUHV\VWHP7KH IDFW
WKDW&DQDGD¶VKHDOWKFDUHV\VWHPLVDPL[RIIRUSUR¿WQRQSUR¿WDQGSXEOLFLV
REYLRXV0DQ\SULYDWHIRUSUR¿WFRPSDQLHVVXFKDVODERUDWRU\JLDQWV/LIH/DEV
IRUPHUO\0'6 *DPPD'\QDFDUHDQG&DQDGLDQ0HGLFDO/DERUDWRULHV &0/ 
PDNHWKHEXONRIWKHLUPRQH\IURPSXEOLFIXQGVDQGRIWHQGRQRWFKDUJHSDWLHQWV
GLUHFWO\IRUWKHLUVHUYLFHV2QWKHRWKHUKDQGKRVSLWDOVDUHOHJDOO\SULYDWHQRQ
SUR¿WFRUSRUDWLRQVWKDWUHJXODUO\FRQWUDFWRXWVRPHRIWKHLUVHUYLFHVWRIRUSUR¿W
FRPSDQLHVDQGRFFDVLRQDOO\FKDUJHSDWLHQWVGLUHFWO\IRUFDUH7KLVEOXUULQJRI
WKHOLQHVEHWZHHQWKHSXEOLFDQGSULYDWHUHÀHFWVWKHSHQHWUDWLRQRIWKHPDUNHW
LQWRWKLVFRUHJRYHUQPHQWSURJUDP,WPXGGLHVWKHZDWHUVRISRSXODUGHEDWHDQG
LVRIWHQXVHGDVDOHYHUWRLQFUHDVHPDUNHWLQYROYHPHQW+RZWKHWHUPVSXEOLF
DQGSULYDWHDUHXVHGLVDVPXFKDSROLWLFDOPDWWHUDVDVHPDQWLFRQH
 0RVW&DQDGLDQVSHUFHLYHSXEOLFKHDOWKFDUHVHUYLFHVWREHWKRVHWKH\UH
FHLYHDVDULJKWRIFLWL]HQVKLSXQGHUWKH&DQDGD+HDOWK$FWWKLVLQFOXGHVPRVW
ODERUDWRU\VHUYLFHV:KLOHWKLVSHUFHSWLRQLVKHOSIXOLQPDLQWDLQLQJEURDGDFFHVV
DQGVXSSRUWIRUXQLYHUVDOKHDOWKLQVXUDQFHLWKLGHVTXHVWLRQVRIRZQHUVKLSDQG
FRQWURODELDVUHÀHFWLQJFDSLWDOLVWVRFLHWLHV¶WHQGHQF\WRIRFXVRQLQGLYLGXDO
FRQVXPHUVUDWKHUWKDQWKHVRFLDOV\VWHPRISURGXFWLRQ
 7KH FRQIXVLRQ LV UHLQIRUFHG E\ D FODVVL¿FDWLRQ V\VWHP FRPPRQ DPRQJ
DFDGHPLFVWKDWXVHVDMXULGLFDODSSURDFKWRFDWHJRUL]HKHDOWKFDUHLQVWLWXWLRQV
DVHLWKHUSXEOLFWKRVHGLUHFWO\SDUWRIWKHFLYLOVHUYLFHRUSULYDWHLQFOXGLQJ
QRQSUR¿WKRVSLWDOVGRFWRUVDQGIRUSUR¿WSURYLGHUV 'HEHU :KLOHWKH
JRYHUQDQFHVWUXFWXUHRILQVWLWXWLRQVFDQEHLPSRUWDQWLQWKLVFRQWH[WWKHFODV
VL¿FDWLRQLVRIWHQXVHGWRXQGHUFXWWKHSURJUHVVLYHXVHRIWKHWHUP³SULYDWL]D
WLRQ´EHFDXVHLWGH¿QHVPRVWFXUUHQWKHDOWKFDUHGHOLYHU\DVSULYDWHPDNLQJ
SULYDWL]DWLRQ D QRQLVVXH 'XQFDQ 6LQFODLU IRUPHU FKDLU RI 2QWDULR¶V +HDOWK
6HUYLFH5HVWUXFWXULQJ&RPPLVVLRQXVHGWKLVDSSURDFKLQD&%&UDGLRLQWHUYLHZ
RQ0DUFKWRGRZQSOD\WKHVLJQL¿FDQFHRIPRYLQJDQFLOODU\VHUYLFHVRXW
Medical Laboratories and the Public-Private Debate 13

RIKRVSLWDOV7KHJRYHUQDQFHDSSURDFKDOVRLJQRUHVWKHLQFUHDVLQJFHQWUDOL]DWLRQ
RIKHDOWKFDUHGHFLVLRQPDNLQJLQPRVWSURYLQFHVKRVSLWDOVDQGRWKHUKHDOWK
VHUYLFHVDUHFRPLQJPRUHDQGPRUHXQGHUGLUHFWJRYHUQPHQWFRQWUROUHJDUGOHVV
RIWKHLUOHJDOLQFRUSRUDWLRQ
 $GLVWLQFWLRQFHQWUDOWRWKLVERRNRQHWKDWLVLPSRUWDQWWRXQGHUVWDQGLQJRXU
PHGLFDOODERUDWRU\V\VWHPDQGFUXFLDOWRWKHIXWXUHRIRXUKHDOWKFDUHV\VWHPLV
WKHGLVWLQFWLRQEHWZHHQFRUSRUDWLRQVWKDWRSHUDWHIRUSULYDWHSUR¿WDQGSURYLGHUV
WKDWDUHQRQSUR¿WRSHUDWLQJZLWKLQVRPHEURDGO\GH¿QHGQRWLRQRISXEOLFJRRG
,QWKLVERRNUHIHUHQFHVWRSULYDWHODEVDQGRWKHUSULYDWHKHDOWKFDUHVHUYLFHVDUH
UHIHUHQFHVWRIRUSUR¿WFRUSRUDWLRQVLHFRPSDQLHVWKDWQHHGWRSD\GLYLGHQGV
WRWKHLULQYHVWRUV
 1RQSUR¿WHQWLWLHVLQFOXGHWKRVHUXQGLUHFWO\E\WKHJRYHUQPHQWDVZHOO
DV QRQSUR¿W FRUSRUDWLRQV VXFK DV KRVSLWDOV WKH 9LFWRULDQ 2UGHU RI 1XUVHV
FRPPXQLW\KHDOWKFHQWUHVDQGWKH&HQWUH/RFDOGH6HUYLFHV&RPPXQDXWDLUHV
LQ4XHEHF:KLOHWKHUHDUHVLJQL¿FDQWGLIIHUHQFHVZLWKLQWKLVJURXSWKH\VKDUH
DSULPDU\LQWHUHVWLQGHOLYHULQJKHDOWKFDUHIRUFROOHFWLYHEHQH¿WUDWKHUWKDQWR
PDNHDUHWXUQRQLQYHVWPHQW3UR¿WLVQRWSDUWRIWKHLUGHFLVLRQPDNLQJHTXDWLRQ
 2QHJURXSWKDWLVFHQWUDOWRWKHVWRU\RIWKHIRUSUR¿WODERUDWRULHVGRHVQRW
QHDWO\¿WLQWRWKLVGLFKRWRP\XQLQFRUSRUDWHGSULYDWHSUDFWLFHSK\VLFLDQV0RVW
OLNHO\WKHJRDOVRIPRVWRIWKHVHSUDFWLWLRQHUVDUHWRPD[LPL]HWKHLUSHUVRQDO
LQFRPHZLWKLQWKHIXQGLQJLQFHQWLYHVGHOLYHUDVHUYLFHDQGSD\WKHLUELOOV7KHUH
DUHRIFRXUVHVRPHZKRXVHWKHLUSRVLWLRQDVDVSULQJERDUGWRFRUSRUDWHPHGL
FLQHDQGWKHH[SORLWDWLRQRILQVXUDQFHVFKHPHVIRUH[WUDRUGLQDU\SULYDWHJDLQ
DQGSRZHU7KLVSUDFWLFHLVYHU\HYLGHQWLQWKHKLVWRU\RISULYDWHODERUDWRULHV
7KHUHDUHIRUH[DPSOHWKHFDVHVRI'U-RKQ0XOODSDWKRORJLVWZKRSDUOD\HG
KLVSUDFWLFHLQWR&DQDGLDQ0HGLFDO/DERUDWRULHV'U7$.DVSHUZKRIRXQGHG
.DVSHU/DERUDWRULHVLQ$OEHUWDDQG'U&DP&RDG\DQGWKHFRQVRUWLXPRISD
WKRORJLVWVZKRIRXQGHG%&%LRPHGLFDOODERUDWRULHV
 7KH G\QDPLF RI WXUQLQJ WKHLU SURIHVVLRQ LQWR DQ LQYHVWPHQW RSSRUWXQLW\
FRQWLQXHVZLWKWKHOLNHVRI'RFWRUV%ULDQ'D\DQG5REHUW2XHOOHWERWKUHFHQW
SDVWSUHVLGHQWVRIWKH&DQDGLDQ0HGLFDO$VVRFLDWLRQZKRXVHGWKHLUPHGLFDO
FUHGHQWLDOV WR IRXQG IRUSUR¿W FRUSRUDWLRQV DQG PDNH VLJQL¿FDQW DPRXQWV RI
PRQH\IURPWKHSXEOLFSXUVH,WLVDSUHGLFWDEOHRXWFRPHRIWKHLQGLYLGXDODX
WRQRPRXVSUDFWLFHPRGHOGRPLQDQWDPRQJ&DQDGLDQSK\VLFLDQV
 'RFWRUVDVDJURXSKDYHDOVRXVHGWKHLULQÀXHQFHWRV\VWHPDWLFDOO\ZRUN
DJDLQVWSXEOLFQRQSUR¿WRSWLRQVZKHWKHU¿JKWLQJXQLYHUVDOKHDOWKLQVXUDQFH
GHPDQGLQJWKHULJKWWRH[WUDELOOSDWLHQWVRUFDOOLQJIRUPRUHLQQRYDWLRQ IRU
ZKLFKUHDGPRUHIRUSUR¿WSDUWLFLSDWLRQ LQWKH&DQDGLDQKHDOWKFDUHV\VWHP
2QH OHVVRQ IURP WKH HYROXWLRQ RI ODERUDWRU\ VHUYLFHV LV WKDW SULYDWH SUDFWLFH
SK\VLFLDQVZKRELOOIHHIRUVHUYLFHDUHPRUHOLNHO\WRFKDOOHQJHWKHFROOHFWLYH
SURYLVLRQRIKHDOWKFDUHWKDQWKRVHSULPDULO\DVVRFLDWHGZLWKSXEOLFKRVSLWDOV
ZKRDUHPXFKPRUHOLNHO\WRVXSSRUWDXQLYHUVDOLQWHJUDWHGDFFHVVLEOHKHDOWK
FDUHV\VWHP
14 False Positive

How Medical Laboratories Work


7RXQGHUVWDQGWKHSROLWLFDOHFRQRP\RI&DQDGD¶VPHGLFDOODERUDWRU\LQGXVWU\
LWKHOSVWRKDYHDJHQHUDONQRZOHGJHRIKRZSDWLHQWVDUHFODVVL¿HGDQGZKDW
WKHNH\FRPSRQHQWVRIWKHPHGLFDOODERUDWRU\V\VWHPDUH$FHQWUDOFRQFHUQLQ
SROLF\GHEDWHVRQPHGLFDOODERUDWRULHVLVKRZVHUYLFHVDUHSURYLGHGWRGLIIHUHQW
W\SHVRISDWLHQWV7KUHHFRPPRQFODVVL¿FDWLRQVRISDWLHQWVDUHLQSDWLHQWVZKR
DUHDVVLJQHGDEHGLQDKRVSLWDORXWSDWLHQWVZKRUHFHLYHPHGLFDOVHUYLFHVLQD
KRVSLWDOEXWDUHQRWDVVLJQHGDEHGDQGFRPPXQLW\SDWLHQWVZKRUHFHLYHPHGLFDO
VHUYLFHVLQWKHFRPPXQLW\PRVWRIWHQIURPDIDPLO\SK\VLFLDQ)RUWKHSXUSRVHV
RIWKLVERRNSDWLHQWVDUHXVXDOO\GLYLGHGLQWRRQO\WZRJURXSVLQSDWLHQWVZKR
UHFHLYHWKHLUODERUDWRU\VHUYLFHVZKLOHVWD\LQJLQWKHKRVSLWDOSDLGIRURXWRI
WKHKRVSLWDO¶VEXGJHWDQGFRPPXQLW\SDWLHQWVLQFOXGLQJERWKRXWSDWLHQWVDQG
FRPPXQLW\SDWLHQWVZKRPD\GHSHQGLQJRQWKHSURYLQFHKDYHWKHRSWLRQRI
KDYLQJWKHLUODERUDWRU\ZRUNGRQHLQDKRVSLWDORUE\DIRUSUR¿WFRUSRUDWLRQ
7KHSULPDU\GHEDWHRQIRUSUR¿WSURYLVLRQRIODERUDWRU\ZRUNIRFXVHVRQKRZ
DQGZKHUHFRPPXQLW\SDWLHQWVVKRXOGKDYHWKHLUVDPSOHVSURFHVVHGDQGKRZ
WKHVHVKRXOGEHSDLGIRU
 6FKHPDWLFDOO\ODERUDWRU\ZRUNFRQVLVWVRIWDNLQJDVDPSOHWUDQVSRUWLQJLWWR
DODEDQDO\]LQJLWDQGFRQYH\LQJXVHIXOUHVXOWVEDFNWRWKHKHDOWKFDUHSURYLGHU
DQGSDWLHQW6LQFHPRVWVDPSOHVDUHVPDOOWKH\FDQHDVLO\EHWUDQVSRUWHGWRD
IDFLOLW\IRUHYDOXDWLRQ7KHSDWKDVDPSOHWDNHVGHSHQGVXSRQWKHSDWLHQWWKH
ODERUDWRU\DQGWKHSURIHVVLRQDOVLQYROYHG3DWLHQWVLQKRVSLWDOVXVXDOO\KDYHWKHLU
EORRGWDNHQE\DQXUVHDQGWKHQLWLVVHQWWRDQRQVLWHODERUDWRU\IRUSURFHVVLQJ
7KHUHVXOWVDQGLQWHUSUHWDWLRQDUHTXLFNO\DYDLODEOHWRWKHDWWHQGLQJPHGLFDOVWDII
3DWLHQWVLQWKHFRPPXQLW\RIWHQKDYHWKHLUEORRGWDNHQLQDVSHFLPHQFROOHFWLRQ
FHQWUH 6&& RUEOHHGLQJVWDWLRQRIWHQORFDWHGLQDEXLOGLQJWKDWDOVRKRXVHV
GRFWRUV0RVWRIWKHVHVDPSOHVDUHWUDQVSRUWHGWRDFHQWUDOSURFHVVLQJIDFLOLW\
XVXDOO\LQDQRWKHUFLW\)D[PDLOSKRQHDQGFRPSXWHUDUHXVHGWRLQIRUPWKH
SK\VLFLDQRIWKHUHVXOWV$QRWKHURSWLRQERWKLQKRVSLWDOVDQGWKHFRPPXQLW\
LVSRLQWRIFDUHWHVWLQJLQZKLFKDVDPSOHLVWHVWHGLQDGRFWRU¶VRI¿FHRUDW
WKHEHGVLGH7KHUHODWLRQVKLSVEHWZHHQVSHFLPHQFROOHFWLRQWHVWLQJUHSRUWLQJ
DQGLQWHUSUHWLQJDUHPRUHFRPSOLFDWHGWKDQWKHVHVLPSOHVFKHPDWDVXJJHVW%XW
KRZWKHVHEDVLFHOHPHQWVDUHGHOLYHUHG¿QDQFHGDQGFRRUGLQDWHGDUHWKHFHQWUDO
FRQFHUQVRIPHGLFDOODERUDWRU\SROLF\FRQVLGHUHGLQWKLVERRN
 $QLPSRUWDQWDVSHFWRIPHGLFDOODERUDWRU\ZRUNQRWFRYHUHGLQWKLVERRN
LVSXEOLFKHDOWKVHUYLFHV7KLVGHFLVLRQZDVPDGHSULPDULO\IRUVSDFHUHDVRQV
3XEOLFKHDOWKODERUDWRULHVSURYLGHDQLQYDOXDEOHSXEOLFVHUYLFHEXWDFFRXQWIRU
OHVVWKDQSHUFHQWRIODERUDWRU\H[SHQVHVDQGWRGRMXVWLFHWRVRPHRIWKHFRP
SOH[LWLHVLQWKHLUGHYHORSPHQWZRXOGKDYHWDNHQPRUHSDJHVWKDQDUHSRVVLEOH
LQWKLVYROXPH
 0RVWGDWDLQWKLVERRNFRPHIURPUHVHDUFKIRUP\PDVWHU¶VWKHVLVRQWKH
SROLWLFDOHFRQRP\RI2QWDULR¶VPHGLFDOODERUDWRU\LQGXVWU\ 6XWKHUODQG 
7KH¿QGLQJVUHO\RQH[WHQVLYHUHVHDUFKLQWKH$UFKLYHVRI2QWDULRDQGRQFRQ
¿GHQWLDOLQWHUYLHZVZLWKNH\LQIRUPDQWV2QWDULRDOVRRFFXSLHVDODUJHVSDFH
Medical Laboratories and the Public-Private Debate 15

LQWKLVERRNEHFDXVHWKHFRUSRUDWLRQVWKDWGRPLQDWHSULYDWHPHGLFDOODERUDWRU\
VHUYLFHVLQ&DQDGDKDYHWKHLUURRWVLQ2QWDULR7KHSROLFLHVRIVXFFHVVLYH2QWDULR
JRYHUQPHQWV RI DOO SROLWLFDO VWULSHV XQGHU WKH UXEULF RI SXEOLF PHGLFDO DQG
KRVSLWDOLQVXUDQFHKDYHDOORZHGWKHVHFRPSDQLHVWRÀRXULVK8QGHUVWDQGLQJ
WKLVSURFHVVLQ2QWDULRKHOSVRQHWRXQGHUVWDQGPDQ\RIWKHGHYHORSPHQWVWKDW
KDYHWDNHQSODFHLQRWKHUSURYLQFHV
 )LIW\\HDUVDJRPRVWFRPPXQLW\VSHFLPHQVZHUHDQDO\]HGE\SXEOLFLQVWLWX
WLRQV KRVSLWDOVDQGSXEOLFKHDOWKODERUDWRULHV RUE\GRFWRUVLQSULYDWHSUDFWLFH
7RGD\LQPDQ\SURYLQFHVIRUSUR¿WFRUSRUDWLRQVSOD\DVLJQL¿FDQWUROH7KLV
WUDQVIRUPDWLRQKDVEHHQSDUWLFXODUO\SURIRXQGLQ2QWDULRZKHUHRYHUSHUFHQW
RIFRPPXQLW\ODEVHUYLFHVDUHSURYLGHGE\WKUHHPXOWLQDWLRQDOV

Cost and Integration


7KLV ERRN HYDOXDWHV WKH LPSDFW RI IRUSUR¿W FRUSRUDWLRQV RQ WKH GHOLYHU\ RI
ODERUDWRU\VHUYLFHVIRFXVLQJRQV\VWHPFRVWDQGLQWHJUDWLRQ5HGXFLQJWKHFRVW
RIODERUDWRU\VHUYLFHVKDVEHHQDFHQWUDOSROLF\JRDORIDOOSURYLQFHVZLWKIRU
SUR¿WODERUDWRULHVVLQFHWKHLQWURGXFWLRQRIPHGLFDUH7KLVVWXG\LVUHVWULFWHGWR
WKHFRVWWRWKHJRYHUQPHQWRISURYLGLQJPHGLFDOO\QHFHVVDU\ODERUDWRU\VHUYLFHV
,WGRHVQRWLQFOXGHIRULQVWDQFHRWKHUVRFLDOFRVWVLQFXUUHGE\XVLQJIRUSUR¿W
FRPSDQLHVHJZRUNHUVZKRDUHSDLGOHVVRUFRVWVWRVPDOOHUFRPPXQLWLHVDVD
UHVXOWRIKDYLQJODERUDWRU\VHUYLFHVFHQWUDOL]HGLQDIHZODUJHSRSXODWLRQFHQWUHV
:KLOHWKHVHDUHLPSRUWDQWVRFLHWDOFRQVLGHUDWLRQVDQGQHHGWREHVWXGLHGWKH\
DUHRXWVLGHWKHVFRSHRIWKLVERRN7KLVERRNGRHVQRWVLPSO\DVVXPHWKDWFRVW
UHGXFWLRQLVWKHXOWLPDWHJRRG&OHDUO\WKHUHDUHRWKHUVRFLDOJRDOVWKDWZRXOG
MXVWLI\DJRYHUQPHQWFKRRVLQJPRUHH[SHQVLYHDOWHUQDWLYHV3URYLGLQJDGHTXDWH
SD\DQGZRUNLQJFRQGLWLRQVJRRGDFFHVVIRUDOOSDWLHQWVDQGVXSHULRUTXDOLW\
HDVLO\FRPHWRPLQG
 $ORQJZLWKFRVWFRQWUROWKHLQWHJUDWLRQRIODERUDWRU\VHUYLFHVKDVEHHQD
NH\SROLF\REMHFWLYHRIDOOSURYLQFLDOJRYHUQPHQWVWKH2QWDULRJRYHUQPHQWKDV
KDGWKLVREMHFWLYHVLQFH,QWKLVERRNLQWHJUDWLRQLVXVXDOO\XVHGLQWKHSRVL
WLYHVHQVHRIPD[LPL]LQJWKHHI¿FLHQWXVHRIUHVRXUFHVDQGIURPWKHSDWLHQWV¶
SHUVSHFWLYHRIFRRUGLQDWLRQIRULPSURYHGTXDOLW\DQGDFFHVVLEO\%XWLQWHJUDWLRQ
LVQRWDQXQTXDOL¿HGJRRG&HQWUDOL]LQJVHUYLFHVFDQGHFUHDVHDFFHVVKXUWWKH
DELOLW\RIVPDOOHUFRPPXQLW\KRVSLWDOVWRSURYLGHEDVLFODERUDWRU\VHUYLFHVDQG
GHFUHDVHTXDOLW\RIFDUHE\FUHDWLQJEDUULHUVEHWZHHQSUDFWLVLQJSK\VLFLDQVDQG
ODERUDWRU\ VSHFLDOLVWV 7KH LQWHUDFWLRQV EHWZHHQ UHVRXUFHV VSHQW RQ VHUYLFHV
WKHLUTXDOLW\DFFHVVLELOLW\DQGGHPRFUDF\DUHDQLPSRUWDQWSDUWRIWKLVVWRU\)RU
H[DPSOHTXDOLW\FRQVLGHUDWLRQVZHUHFHQWUDOWRHDUO\LQLWLDWLYHVE\JRYHUQPHQWV
WRUHJXODWHSULYDWHFRUSRUDWLRQVDQGSOD\HGDUROHLQWKHLUFRQVROLGDWLRQ
 $UHDVRQWRIRFXVRQFRVWLVWKDWVXSSRUWHUVRIPRUHIRUSUR¿WLQYROYHPHQW
LQODERUDWRU\VHUYLFHVFODLPWKDWLWZLOOUHGXFHFRVW,QHVVHQFHWKLVLVDFULWLTXH
RI WKDW SRVLWLRQ &RVW FRQWURO DQG LQWHJUDWLRQ RI ODERUDWRU\ VHUYLFHV DUH WZR
SROLF\SUHVFULSWLRQVZLWKEURDGVXSSRUWDFURVVWKHFRXQWU\DQG\HWWKH\KDYH
QHYHUEHHQVXFFHVVIXOO\LPSOHPHQWHG7KHIRFXVRQFRVWDQGLQWHJUDWLRQDOVR
16 False Positive

SURYLGHVDQRSHQLQJWKURXJKZKLFKZHFDQH[SORUHDQDOWHUQDWLYHDSSURDFKWR
XQGHUVWDQGLQJJRYHUQPHQWSROLF\WKHLQWHUDFWLRQRIJRYHUQPHQWVZLWKIRUSUR¿W
SURYLGHUVDQGWKHVWUXJJOHRYHUUHVRXUFHVDWWKHFHQWUHRIWKHDQDO\VLV
 7KLVVWXG\RI&DQDGD¶VPHGLFDOODERUDWRU\VHUYLFHVSD\VVSHFLDODWWHQWLRQ
WRWKUHHWKHPHVLPSRUWDQWWRXQGHUVWDQGLQJKRZDIHZVPDOOIRUSUR¿WODERUDWR
ULHVOHGWRWKHULVHRIPXOWLQDWLRQDOIRUSUR¿WODERUDWRU\FRUSRUDWLRQV7KH¿UVW
WKHPHLVWKHLQWHUDFWLRQVEHWZHHQIRUSUR¿WFRUSRUDWLRQVDQGJRYHUQPHQWERWK
LQWHUPVRIKRZJRYHUQPHQWVKDYHIDYRXUHGWKHVHVHUYLFHVDQGKRZFRPSDQLHV
KDYHLQÀXHQFHGGHFLVLRQPDNLQJ7KHVHFRQGWKHPHFRYHUVKRZWKHPHGLFDO
SURIHVVLRQDQGPRUHEURDGO\WKHSUDFWLFHRIELRPHGLFLQHKDVEHHQLQVWUXPHQWDO
LQVHWWLQJWKHFRQGLWLRQVIRUSULYDWHGHOLYHU\JLYLQJLWOHJLWLPDF\DQGFRYHULQJ
XSLWVIDLOLQJV7KLUGZHORRNDWFKDQJHVLQODERUDWRU\SROLF\RYHUWKHODVWIRUW\
\HDUVZKLFKSURYLGHVLQVLJKWVLQWRKRZFKDQJHVLQWKHJOREDOHFRQRP\LPSDFW
WKHGHOLYHU\RIORFDOVHUYLFHV

Outline of the Book


7KH¿UVWFKDSWHUGHVFULEHVWKHGHYHORSPHQWRIDVWURQJQDWLRQDOQRQSUR¿WODER
UDWRU\V\VWHPEHIRUHWKH0HGLFDO&DUH$FWRIDQGVRPHRIWKHLQÀXHQFHV
ODUJHO\IURPWKHPHGLFDOFRPPXQLW\WKDWOLPLWHGLWVUHDFKDQGODLGWKHEDVLVIRU
WKHGHYHORSPHQWRIDIRUSUR¿WVHFWRU7KHVHQRQSUR¿WVHUYLFHVZHUHSULPDULO\
GHOLYHUHGWKURXJKSXEOLFKHDOWKGHSDUWPHQWVDQGLQKRVSLWDOVZKLFKFRQWLQXH
WREHWKHEDFNERQHRIRXUPHGLFDOODERUDWRU\V\VWHP
 &KDSWHU7ZRH[DPLQHVWKHFKDQJHVLQ2QWDULRJRYHUQPHQWSROLF\IURP
WRWKDWIDFLOLWDWHGWKHULVHRIIRUSUR¿WODERUDWRU\FRUSRUDWLRQVIURPWKH
IHZVPDOOSULYDWHODEVWKDWZHUHDOORZHGWRH[LVWEHIRUHPHGLFDUH$WWKHVDPH
WLPHWKDW2QWDULR¶V&RQVHUYDWLYHJRYHUQPHQWVZHUHHVWDEOLVKLQJVWUXFWXUHVWKDW
IDFLOLWDWHGIRUSUR¿WJURZWKWKH\ZHUHFRQFHUQHGDERXWWKLVH[SDQVLRQ&KDSWHU
7KUHHGHVFULEHVWKHVXSSRUWJLYHQLQ2QWDULRWRQRQSUR¿WFRPPXQLW\ODERUDWRU\
VHUYLFHV &RPSDUHG WR SULYDWH ODERUDWRULHV WKHVH SXEOLF VHFWRU RUJDQL]DWLRQV
ZHUHEHWWHUDEOHWRFRQWUROFRVWVDQGLPSURYHVHUYLFHLQWHJUDWLRQ
 &KDSWHU)RXUH[DPLQHVWKHGHYHORSPHQWVLQODERUDWRU\VHUYLFHVLQ2QWDULR
IURPWR'XULQJWKLVSHULRGZHVDZWKHKHLJKWRIQHROLEHUDOLQÀXHQFH
7KHIHGHUDOJRYHUQPHQWUHGXFHGIXQGLQJWRSURYLQFHVIRUKHDOWKFDUHDQGWKH
1'3JRYHUQPHQWLQ2QWDULRIDFHGZLWKDUHFHVVLRQDQGHVFDODWLQJSXEOLFGHEW
QHJRWLDWHGGLUHFWO\ZLWKWKHIRUSUR¿WODERUDWRU\FRPSDQLHVWRFXWSURYLQFLDOSD\
PHQWVIRUODERUDWRU\VHUYLFHV7KHWUDGHRIIZDVLQFUHDVHGFRQWURODQG¿QDQFLDO
VHFXULW\IRUWKHODUJHSULYDWHODERUDWRULHV
 &KDSWHU)LYHSURYLGHVGHVFULSWLRQVRIWKHWKUHHODUJHVWIRUSUR¿WODERUD
WRU\FRUSRUDWLRQVLQ&DQDGD²/LIH/DEV IRUPHUO\ 0'6 &DQDGLDQ0HGLFDO
/DERUDWRULHV &0/ DQG*DPPD'\QDFDUHDZKROO\RZQHGVXEVLGLDU\RIWKH
VHFRQGODUJHVWODERUDWRU\VHUYLFHVFRUSRUDWLRQLQWKH8QLWHG6WDWHVWKH/DERUDWRU\
&RUSRUDWLRQRI$PHULFD /DE&RUS ²DQGZKDWWKH\KDYHGRQHZLWKRXUKHDOWK
FDUHGROODUV7KHJHQHVLVRIDOOWKUHHFDQEHGLUHFWO\WUDFHGEDFNWRWKHFRUSRUD
WL]DWLRQRISULYDWHGRFWRUV¶SUDFWLFHV
Medical Laboratories and the Public-Private Debate 17

 &KDSWHU6L[RXWOLQHVPHGLFDOODERUDWRU\VHUYLFHVLQWKHRWKHUQLQHSURY
LQFHVIRFXVLQJRQFRQQHFWLRQVEHWZHHQIXQGLQJRZQHUVKLSDQGGHOLYHU\6L[
SURYLQFHV%ULWLVK&ROXPELDWR4XHEHFXVHDPL[RISXEOLFDQGSULYDWHODER
UDWRULHVIRUFRPPXQLW\SDWLHQWV7KHUHKDVUHFHQWO\EHHQDVPDOOPRYHDZD\
IURPXVLQJIRUSUR¿WFRUSRUDWLRQVLQVWHDGJRYHUQPHQWVKDYHEHHQIRFXVLQJRQ
UHVWUXFWXULQJQRQSUR¿WVHUYLFHVDORQJ³EXVLQHVVOLQHV´KDPSHULQJWKHGHOLYHU\
RISXEOLFODERUDWRU\VHUYLFHVDQGSRVVLEO\HDVLQJWKHZD\IRUPRUHSULYDWL]DWLRQ
LQWKHIXWXUH
 &KDSWHU6HYHQDGGUHVVHVWKHDUJXPHQWWKDWIRUSUR¿WODERUDWRULHVKDYHEHHQ
VRVXFFHVVIXOEHFDXVHWKH\SURYLGHPRUHFRVWHIIHFWLYHVHUYLFHDQGKHOSPHHW
JRYHUQPHQWDOJRDOVRIJUHDWHUVHUYLFHLQWHJUDWLRQ:KLOHSUREOHPVRIEXVLQHVV
VHFUHF\DQGVWUXFWXUDOGLIIHUHQFHVEHWZHHQKRVSLWDODQGFRPPXQLW\ODERUDWRU\
V\VWHPVPDNHGLUHFWFRPSDULVRQVGLI¿FXOWWKHDUJXPHQWVDQGDYDLODEOHGDWD
PDNHDFRPSHOOLQJFDVHWKDWIRUSUR¿WODERUDWRU\VHUYLFHVFRVWDWOHDVWSHUFHQW
PRUHWKDQXVLQJQRQSUR¿WLQVWLWXWLRQV$VZHOODVEHLQJPRUHH[SHQVLYHSULYDWH
FRUSRUDWLRQVKDYHSOD\HGDQDFWLYHUROHLQXQGHUFXWWLQJLQWHJUDWLRQLQLWLDWLYHV
8VLQJDIXOO\LQWHJUDWHGQRQSUR¿WODERUDWRU\V\VWHPWRGHOLYHUDOOVHUYLFHVZRXOG
OLNHO\VDYHWKH&DQDGLDQKHDOWKFDUHV\VWHPDWOHDVWPLOOLRQLQ
 &KDSWHU(LJKWFRQWLQXHVWRFKDOOHQJHWKHDUJXPHQWWKDWIRUSUR¿WFRPSDQLHV
SURYLGHDEHWWHUVHUYLFHE\FRQVLGHULQJWKHHIIHFWVRIXVLQJWKHVHFRUSRUDWLRQV
RQTXDOLW\DQGDFFHVV&KDSWHU1LQHUHWXUQVWRWKHGHEDWHRQWKHXVHRIIRUSUR¿W
FRUSRUDWLRQVWRGHOLYHUSXEOLFO\IXQGHGKHDOWKFDUH7KHKLVWRU\RIODERUDWRU\
VHUYLFHVLQ&DQDGDSURYLGHVHYLGHQFHWKDWIRUSUR¿WGHOLYHU\ZRUNVDJDLQVWWKH
VXVWDLQDELOLW\DFFHVVLELOLW\TXDOLW\DQGGHPRFUDWLFFRQWURORIRXUSXEOLFKHDOWK
FDUH V\VWHP ,W LV UHFRPPHQGHG WKDW IHHIRUVHUYLFH SD\PHQWV IRU ODERUDWRU\
VHUYLFHVEHHQGHGDQGWKDWDWUDQVLWLRQWRDIXOO\LQWHJUDWHGSXEOLFQRQSUR¿W
ODERUDWRU\VHUYLFHEHJLQ

Potrebbero piacerti anche