Background
The title “Commoditisation of Pathology” is provocative but it is prompted by the feeling in the industry and more prominently in the medical community, that governments around the world may not perceive the value of pathology to healthcare. Events in New Zealand with the change in a major pathology provider and controversy over the overseas outsourcing of pap smears in Ireland, all contribute to a sentiment that pathology is “unimportant”. Furthermore there is a widespread ignorance of what pathology is by the general public. In general there are concerns from some quarters that the current local funding arrangements threaten the sustainability of pathology services and will have deleterious consequences for the workforce.

A counter view to the above might be that the reimbursement structure together with the technology and organizational arrangement applied by laboratories have contributed to great efficiencies which have delivered to the general benefit of the community in terms of cost and availability of testing. This might be at the cost to pathologists of professional consultation with individual referrers and limited ability to influence practice and the feeling of being commoditised, but in total the overall goal for Government and taxpayers is one of accessible and affordable testing. 

In response to the recent budgetary changes some pathology providers have reduced bulk billing of pathology charges thus resulting in patients having to make co-payments. These have been widely condemned by the Federal Health Minister who has indicated that the profits of Private Pathology Providers are sufficient to absorb the budgetary changes and bulk billing should not decrease. One can also hypothesise that the financial arm of government may well want a price signal (co-payment) to be sent to both referrers and patients and be entirely happy with a decrease in bulk billing and eventually reduced requesting. 

The role of co-payments is a controversial area in health economics and evidence from the way pathology funding operates in UK and US suggests that the co-payment-price signal does not work. In which case should we looking at other funding models apart from fee for service? The report from the National Health and Hospital Reform Commission makes no specific mention of pathology but does talk about changes to funding models that are based on outcome or episode rather than fee for service.

Aims

The major issues which we might want to examine are:

1.    Does this perception of commoditisation really exist and if so can we reverse it? 
2.    How might pathology be funded in the future and what are better models?
3.    Is the current demand/usage of pathology testing of no value to the community?

Areas to be covered by speakers:

Jane Hall (Health Economist)
1.    What alternatives exist to fee for service funding models - UK and US experiences to be considered?
2.    How to assess economic value of interventions including difficult areas such as testing and future role of MSAAC?
3.    The role of co-payments to control demand -  pro and cons?
4.    What are the implications of the recent NHHRC report?

Andrew Goodsall (Market Analyst)
1.    What is the current state of the 3 main private pathology players 
2.    How are the big 3 reacting now and what may they do in the future in response to the current situation? 
3.    Is the pathology industry a good investment ?
4.    What the market might look like in 3-5 years time?
5.    What value is pathology to the Australian economy?

Claire Bayram (Senior research officer, University of Sydney)
1.    Evidence from the Beach study to show the value of pathology to GPs
2.    Should we be doing more pathology and/or different testing?
3.    In the light of good evidence of the value of pathology why is the Government not listening?

Trevor English (General Manager, Canterbury Health Laboratories, New Zealand)
Trevor will discuss what is happening to pathology in New Zealand in the light of the background above and he can compare and contrast to his experiences in Australia.

Gregg Flynn  (Pathologist, Ontario, Canada).
Gregg will discuss the Canadian pathology market and its relevance to Australia

Robert Michel (Editor In Chief of The Dark Report)
Robert is Chair and as part of the panel discussion and will add the US perspective.