Healthcare in the United States and the practice of laboratory medicine

US healthcare and the impact of the changes in the healthcare system on the current and future practice of laboratory medicine are analyzed. Factors considered include - population and government, healthcare expenditure, organization of healthcare delivery (institutions, personnel, healthcare industry, knowledge-personnel production, financing), the impact of managed care, and political and public health issues. The effect of the changing healthcare scene on laboratories and the consequent cost-containment measures for laboratory medicine are examined, including centralization, consolidation, supplier relationships, reengineering and automation (total lab automation), expert systems, CQI, and the move to point-of-care testing. (C) 1997 Elsevier Science B.V.