Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure.

Ozayr H Mahomed,Naseem Cassim,Ruth Lekalakala,Shaidah Asmall

doi:10.4102/ajlm.v5i1.339

Abstract

BackgroundDiagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.ObjectivesThis study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.MethodsA retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.ResultsApproximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.ConclusionsConsiderable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

Highlights

Diagnostic health laboratory services are regarded as an integral part of the national health system across all countries and have an important role in the continuum of care
4.5 million tests accounted for approximately R339 million in laboratory expenditures for diagnostic laboratory tests at the primary healthcare (PHC) facilities in the 11 districts during the financial year (FY) 2013/2014 study period (Table 1)
Of all laboratory expenditures for FY 2013/2014, 21 tests were responsible for ~92% (R310 million) of the total (Table 2)

Summary

Introduction

Diagnostic health laboratory services are regarded as an integral part of the national health system across all countries and have an important role in the continuum of care. The National Health Laboratory Service (NHLS) provides diagnostic laboratory services for the South African public health sector through over 300 laboratories across the nine provinces, thereby achieving 80% population coverage.[2] The NHLS is reimbursed by the Provincial Departments of Health on a fee-for-service billing arrangement.[2] Through this payment mechanism, laboratory tests are itemised as tariff codes on an invoice, for example, tariff code 2210 denotes the haemoglobin test. These funds are obtained from the provincial equitable share portion of the national health budget. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes

Objectives

Results

Conclusion