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Public health laboratories are the first line of defense in the fight against communicable diseases and bioterrorism. The local public health laboratories in particular serve important functions including the identification and monitoring of pathogens in the community. They have the ability to respond to individual challenges within their jurisdictions with creative and innovative solutions. Unfortunately, instead of investing in and expanding the functions of their public health laboratory, many jurisdictions are forced by budget cuts, workforce shortages, and competition with private/commercial laboratories, to consider downsizing or closure of these essential facilities.2-4 California has been especially targeted by reorganization approaches, including regionalization, consolidation and privatization, because it has a unique, decentralized system consisting of one state- and 35 local laboratories, many more than other states.5 Reorganization, however, might be applicable only in a few isolated settings and faces opposition from many lab directors and health officers.2 It would result in further public health laboratory closures to the detriment of the overall mission of public health.

It would be imperative to strengthen the local public health laboratories, improve their cost-effectiveness and maintain their quality service. This could be achieved through specimen volume increases in certain testing areas. Economies of scale would arise due to costs being distributed over more samples, and quality might be improved. One strategy to achieve volume increases is specialization, or the sharing of testing services amongst several neighboring public health laboratories. If focused on the particularly cost-inefficient low-to-moderate volume tests, specialization might be able to achieve the greatest benefits. It was the goal of this research to identify the current level of support for and the prevalence of specialization in low-to-moderate volume tests in the local jurisdictions of California and to examine how feasible wider implementation would be. Additionally, a Cost-Effectiveness Evaluation Model was developed to evaluate past or future service changes, such as volume increases or service sharing, based on their effect on the cost, revenue and quality of testing. Overall, this alternative strategy to strengthen the public health laboratories was examined so that public health policy makers, administration, and lab directors can make a more informed decision about the future of their public health laboratory.

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