-----Original Message-----
From: Myers, Martin [SMTP:[log in to unmask]]
Sent: Wednesday, 3 July 2002 19:24
To: [log in to unmask]
Subject: path modernisation
Colleagues,
Although the English Pathology modernisation debate may seem a bit
parochial, the debate would benefit from an international input.
In England an average pathology laboratory serves about 800-1400 beds and a
population of about 300 000 to 400 000. It receives about 300 000 requests
and perform just under 2 million tests. One central theme (but there are
many other very important themes) is that Pathology should be delivered to
a
larger user base (possible up to a population of 2 million) within a single
management structure. Have international colleagues any experiences on
delivering managed pathology to populations of this size? What are the
benefits and dis-benefits? Is there a theoretical maximum efficiency which
is based on Clinical needs, geography etc? Have we (almost) got it right
in
the UK or should we be learning from the international experience?
Some international input from Sydney.
In Australia there are public sector and private sector pathology
organisations. The public sector laboratories are based in public hospitals
and mostly serve patients who are in those hospitals or afilliated ones,
and ambulatory patients being seen in clinics or in the rooms of
consultants to the hospital. The private sector, which has consolidated,
grown and become quoted on the stock exchange over the past five years or
so, mostly serves patients of GPs and of specialists who prefer to use the
private sector (either because they offer a better service or in some cases
for ideological reasons). In some cases private laboratories have tried to
take over public hospital work and vice versa, this varies between the
states. In NSW it's not a big factor.
Sydney has a population of 4 million plus, and there are two major private
laboratory groups as a result of all the consolidation. Incidentally, these
two or maybe three groups dominate private pathology across Australia and
as far as I know they manage their businesses quite effectively despite
their size and geographic issues. In the public sector, there are five Area
laboratory services, based on major teaching hospitals and each under the
aegis of one of the Area Health Services. There is some degree of
cross-referral of specialist tests, and each of the Area laboratory
services tends to have its main laboratories at the largest hospital and
offers on-site services at some other hospitals in their Area. This public
sector consolidation has built up over the last five years or so, and I
think it's important that on the whole the consolidation has occured in
parallel with consolidation of hospitals. With some exceptions, each Area
Health Service has a dominant tertiary hospital and some smaller
'community' hospitals.On the whole, modernisation has meant centralisation.
It has also meant budget problems, but these are independent of the
consolidation and might even be worse without it.
Overall, public sector laboratories seem larger than in the UK, they
probably serve a larger population but not the GPs, and they probably each
do more tests per year.
This is for Sydney. Australia is a very urbanised society and this model
might not work out for the UK where there are many more centres to serve.
Cetainly there are significant difficulties in the 'bush' where population
density is low.
Whether this has any lessons for our UK colleagues, I'm not sure. The
pattern seems rather different in the USA, but I'm not familiar with the
details. And probably different again across Europe. One thing which seems
to affect laboratory services (like the rest of healthcare) is the funding
model; obviously the private laboratory sector has grown here because of
fee-for-service payments but, hey, that's capitalism for you. I believe it
did in America too, but maybe managed care has changed this.
John Whitfield
Clinical Biochemistry
Royal Prince Alfred Hospital
Sydney, Australia
Phone (+61) 2 9515 5246
Fax (+61) 2 9515 7931
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