Aberration of French Public Health Authorities policies for the cost-assessment of microbiological diagnosis in ophthalmology

Abstract

Sensitive and specific laboratory tests adapted to ophthalmologic micro specimens are necessary for the clinical management of corneal ulcers (CU). The goal of this work is to analyze the correlation of diagnosis tests specificities with pricing policies for public laboratories. Human specimen procedures were extracted from the National Eye Center Laboratory registers in Paris, France with reimbursement values (pricing) confronting the National Social Security Services. According to cost of reactants and human resources, the official quotation for public laboratories for urinary tract diagnosis is 19 Euros (signals allowing for ruling-out negatives takes less than 2 min) and less than 27 Euros for a comprehensive laboratory diagnosis of CU, which includes testing for bacteria, fungi and protozoa (Acanthamoeba); antibacterial and antifungal susceptibility testing for positive cultures and adapted DNA extraction procedures for viral and protozoa PCR (>1 hour handling). Pricing calculations produced oversimplified conclusions for CU diagnosis, ignoring pathology differences, diagnosis procedures, risks and sphere of action. Comprehensive revision of cost assessment policies and diagnosis pricing should be implemented for specialized laboratories to maintain the quality of public medical care and avoid interruptions in the transmission of knowledge to younger generations.