The growth of managed care is forcing clinical laboratories to produce rapid, efficient testing services and to focus on cost reduction. The clinical testing services market is highly competitive, with large independent reference laboratories increasing the standard in terms of technology, speed of testing, and price.
Public health laboratories need to be agile in adapting to change. They are also challenged by governmental change, such as fluctuations in state funding streams for laboratory services and change in expectations vis-à-vis personal testing in the Medicaid population. Other environmental factors such as the computerization of clinical laboratories and the federal government role in PHL-related issues will continue to challenge the ability of PHLs to accomplish their objectives. These factors contribute to the climate of uncertainty reported by many PHL directors, and underscore the importance of our key study questions