Public Health Laboratories and Health System Change . Conclusions


The PHLs we studied are operating in a highly fluid and challenging environment. While the function of PHLs varies from state to state (each is unique with respect to its approach, the services it offers, and its history), every PHL serves a pivotal role in linking the private and public sectors. Funded by public sources, PHLs are typically intertwined with the private sector as regulator, arbiter of policy concerns, and sometimes competitor as the provider of tests or services.

As detailed in this report, directors of PHLs see fundamental change on both the public and private sides of this complex ledger. On the private side, PHLs see managed care and independent laboratories growing in strength, as well as rapid technological change in both clinical and information technologies. On the public side, PHLs see a re-definition of the public health safety net, reliance on managed care to address public health needs, and tightening state budgets.

This study presents a framework for understanding PHLs in the context of the larger laboratory services marketplace and fundamental changes to the health care system. To develop this framework, we polled PHL directors from every state, interviewed numerous laboratory stakeholders in both the public and private sector, conducted in-depth case studies of three PHLs, and also carried out secondary research.

The purpose of this final section is to summarize what we learned through this study with reference to two fundamental issues: (1) strategic positioning of PHLs and their core functions relative to health system change; and (2) critical policy issues the state and the federal government will face over the coming decade. We also acknowledge the limitations of our study and suggest avenues for further research.