The effect of removal of profile requesting on chemical pathology requesting patterns

Abstract

We investigated the effect on pathology requesting behaviour in a metropolitan teaching hospital, following the proscription by the Health Insurance Commission of the MBA (multiple biochemical analysis) request. Our laboratory had provided a 20 test profile in response to a request for MBA until February 1991, when the MBA request was no longer accepted. During the period February to June 1991, requesting clinicians had to comply with the new requesting requirements, although they continued to receive the results of the 20 test profile because of limitations imposed by our laboratory instrumentation. After June 1991, with the installation of a new analyzer that allowed discretionary requesting, results were provided only for those tests requested. We studied requesting patterns in the 3 time periods: i.e. (1) before the MBA request was withdrawn, and after the MBA request was withdrawn, (2) firstly while results for the 20 test profile were still provided and (3) secondly when the results were provided only for the tests requested. For each of the 3 periods the average number of requests per day for MBA, group and individual tests was calculated. The effect of removal of the MBA request on the Medicare Benefits payable was estimated. We found compliance by the requesting clinicians with the new requirements and a reduction in the number of tests requested. There was a reduction from 20 to 12 in the average number of tests per request. This was associated with a 2.2% reduction in the Medicare Benefits payable.