Cost Containment in the Clinical Laboratory—To Be or to Seem to Be, or When Is a Nontest a Test?

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Abstract
Elsewhere in this issue, Jacobson et al (p 1644) illustrate what seems to be the simplest way in which cost containment may be applied in the clinical laboratory. They show that it is unnecessary to perform many laboratory tests, which previously had been ordered routinely, for one clinical circumstance unless there are specific clinical findings that would increase the yield of positive diagnoses or helpful information from such testing. What the authors propose as an alternative is best called appropriate laboratory utilization. It seems obvious that not performing laboratory tests would result in eliminating the costs of performing such tests and the charges. Thus, persons on whom these tests are not performed (and their third-party payers) escape the charges. But does the public at large avoid the bill for these "nontests"? What actually happens under existing policy of government, other third-party payers, and usual hospital and accounting billing practices amounts

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