I have come to view direct access testing (DAT) as one facet of the high-level trends of decentralization and disintermediation in healthcare. By this I mean that some portion of healthcare will migrate away from hospitals and physician offices and toward consumers. Allowing consumers to order lab tests for themselves, for example, is one chapter in this narrative. Others include the development of bedless hospitals (see: The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology), telemedicine visits with healthcare providers (see: Introduction of the Term "Webside" to Refer to Telemedicine Interactions), and the use web search engines to help consumers interpret their symptoms (see: Paging Dr. Google! We Are Waiting for a Second Opinion). In line with all of this is a recent article in the Dark Daily about DAT (see: Why Healthcare Experts Critical of Direct Access Testing Advise Clinical Laboratories to Take Precautions). Below is an excerpt from it:
DAT enables consumers to request medical lab tests from clinical laboratories without doctors’ orders. It is legal in 29 states and the District of Columbia; 13 states require a physician pre-authorization; and nine others limit the number of tests people can obtain, explained a Lab Tests Online statement....For a growing number of medical laboratories and websites offering blood testing to consumers, DAT is a popular customer service. But prior to taking orders from the consumers, some pathologists say it is important to first carefully select the menu of clinical laboratory tests that will be directly available to the public. Opponents also say DAT can lead to confusion among consumers about which tests are appropriate to order. Consumers can often find it challenging to interpret and understand the lab test results. Another source of confusion can be false positives....DAT has grown from a $15-million business in 2010 to a $131-million business in 2015....But just because you can perform a laboratory test, doesn’t mean you should offer it to consumers,” said Robert Stern, MD, Sonora Quest’s Medical Director....Stern noted that though medical laboratory tests for some diseases and conditions are popular among consumers, the test results are “complex” and “difficult to interpret....So, rather than helping to control healthcare costs, this kind of random or unselected testing can drive up costs—even though lab tests as a percentage of overall healthcare spending is relatively low,” Stern noted.
The term disintermediation has been used in relation to the effect of the migration of businesses to the web. It's defined in the following way (see: disintermediation):
Disintermediation is giving the user or the consumer direct access to information that otherwise would require a mediator, such as a salesperson, a librarian, or a lawyer. Observers of the Internet and the World Wide Web note that these new technologies give users the power to look up medical, legal information, travel, or comparative product data directly, in some cases removing the need for the mediator (doctor, lawyer, salesperson) or at the very least changing the relationship between the user and the product or service provider.
Just think about what computer and smartphone airline apps have done to the travel industry with most consumers now booking their own reservations and avoiding travel agents. Blood drawing stations in neighborhood retail drug stores will disintermediate hospital and reference blood drawing centers. If these same retail drug store begin to deploy point-of-care analyzers and perform common lab tests, the nature of hospital and reference lab testing will be irreversibly changed. This shift will move beyond DAT testing and encompass more physician-ordered lab testing. The view that such disintermediation will drive up lab and healthcare costs does not make sense to me. The cost of DAT testing has historically been far below that charged by hospitals for such services because the latter have included hefty profit margins.