Pathology testing not increased by co-location of services

GOVERNMENT fears that co-location of GP services and pathology collection centres can lead to inappropriate over-ordering of tests have been put to rest by a study showing location does not affect test-ordering rates.

In 2007, the federal government introduced new rules designed to limit what it considered to be undue commercial influences relating to the delivery of diagnostic and pathology services, including kickbacks for referrals.

However, an analysis comparing test-ordering rates over nine years ― between 31 700 GP–patient encounters at co-located practices in metropolitan Sydney and Melbourne, and 289 700 GP encounters at practices that were not co-located ― has not backed the concerns.

After adjusting for practice variables (such as size and accreditation status) and GP characteristics (such as sex, age and number of sessions worked each week), no differences in test-ordering rates were detected between the two types of practices.

“Regulators who are concerned that undue influences and conflicts of interest in the pathology sector may be skewing GPs’ test-ordering behaviour should draw some comfort from this result,” the researchers said.

Fixed prices mostly paid by government and the relatively homogeneous services provided by pathology companies resulted in inelastic demand, the authors said.

“In sum, the nature of pathology markets, however aggressive, may not carry the same risks of supplier-induced demand that exists in markets for health care products, such as pharmaceuticals,” they wrote.

However the researchers did have a caveat.

They cautioned that the changing landscape of health care delivery, including the growth of super clinics, greater integration of GP and diagnostic services and the prospect of higher out-of-pocket pathology costs for patients, needs to be monitored to assess future drivers of test-ordering behaviour.

Med J Aust 2010;193: 114-119.

Posted: 19 July, 2010