Just as the laboratory system in the private sector is consolidating in light of new technology and the need to achieve economies of scale, many believe that consolidation would also be desirable in the public sector. Why should there be 50 state PHLs when geographic borders bear little relation to population centers and disease burdens?
The argument for status quo is typically rooted in political imperative and the need for states to control the full scope of public health services. However, while there is undoubtedly a role for some form of laboratory in every state, this does not mean that all laboratories need to be equally capable. Indeed, there is already considerable variation across states in services provided, and, as we have shown, many states contract out to have tests carried out in other state or private laboratories.
The notion of regionalization needs to be more carefully studied by the CDC. Issues that need to be considered include the capacity of state laboratories to perform complex reference testing, economies of scale in purchasing new capital equipment, mechanisms for laboratory funding, the current role of Medicaid funding, and categorical grants.