The PHLs are part of a broader public health infrastructure responsible for assessment of public health needs, assurance that needs are met, and policy development. But while the state laboratories share this overarching philosophy, the structure, organization, and financing of each state laboratory is different. Each PHL also resides in a unique health system and operates a unique laboratory information system. Therefore, it is understandable that each has pursued a unique strategy in addressing the central issues that we studied.
Managed care and the growth of large commercial laboratories are issues of great concern to PHL directors. We found that nearly half of the PHL directors believe that managed care is having an adverse effect on PHLs. Nearly half of the directors also believe that other health market change, such as the emergence of large private clinical laboratories and hospital consolidation, is negatively affecting PHLs. The main areas of concern include: