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PubMed1994

Rationale for cost-effective laboratory medicine.

There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States.

Clinical Laboratory Techniques↗
PubMed2000

Impact of the Massachusetts tobacco control programme: population based trend analysis.

OBJECTIVE: To assess the impact of the Massachusetts tobacco control programme, which, since its start in January 1993, has spent over $200m-"the highest per capita expenditure for tobacco control in the world"-funded by an extra tax of 25 cents per pack of cigarettes. DESIGN: Population based trend analysis with comparison group. SUBJECTS: Adult residents of Massachusetts and other US states excluding California. MAIN OUTCOME MEASURES: Per capita consumption of cigarettes as measured by states' sales tax records; prevalence of smoking in adults as measured by several population-based telephone surveys. RESULTS: From 1988 to 1992, decline in per capita consumption of cigarettes in Massachusetts (15%) was similar to that in the comparison states (14%), corresponding to an annual decline of 3-4% for both groups. During 1992-3, consumption continued to decline by 4% in the comparison states but dropped 12% in Massachusetts in response to the tax increase. From 1993 onward, consumption in Massachusetts showed a consistent annual decline of more than 4%, whereas in the comparison states it levelled off, decreasing by less than 1% a year. From 1992, the prevalence of adult smoking in Massachusetts has declined annually by 0.43% (95% confidence interval 0.21% to 0.66%) compared with an increase of 0. 03% (-0.06% to 0.12%) in the comparison states (P<0.001). CONCLUSIONS: These findings show that a strongly implemented, comprehensive tobacco control programme can significantly reduce tobacco use.

Adult↗