COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

June 6, 2008

BOARD MEETING DATE:

June 17, 2008

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Brian J. Zamora, Director, Public Health & Environmental Protection Division

SUBJECT:

Public Health Laboratory Fees

RECOMMENDATION:

Adopt a Resolution establishing Public Health Laboratory fees effective July 1, 2008.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal 5: Residents have access to healthcare and preventive care.

This fee increase contributes to this commitment and goal by ensuring that vital public health services are provided at an appropriate fee to recover costs associated with the service provided.

Performance Measure:

Measure

FY 2006-07

Actual

FY 2007-08
Projected

Percent of laboratory proficiency tests each Public Health Microbiologist passes each year.

90%

90%

BACKGROUND:

The Public Health Laboratory provides both clinical and environmental tests to the Health Department, other County departments, private physicians, clinics, hospitals, and the general public. In addition to fees for tests, the Public Health Laboratory charges a fee for processing annual applications for Non-Diagnostic Health Assessment test programs to verify appropriate testing practices. Health and Safety Code §101325 authorizes the County to charge fees to pay the reasonable expenses of the Health Officer incurred in enforcing state laws, regulations and orders relating to public health. The Public Health Laboratory test menu is limited to tests related to core public health services of infectious diseases and environmental protection or are related to chronic diseases preventable by public health measures.

DISCUSSION:

The proposed laboratory fees reflect the increased cost of labor and supplies, including expensive, sophisticated reagents required by new technologies that provide faster, more accurate test results. The proposed fees were determined based on a combination of: an analysis of the cost of providing the range of Public Health Laboratory tests, a review of the competitive environment, and an assessment by the County Health Officer regarding the importance of the test to public health. The fees are generally comparable to those for Santa Clara, San Francisco and Contra Costa Counties.

In some cases tests for diseases such as tuberculosis or rabies are offered below or without cost due to their critical importance for the health of the community-at-large. These are legitimately the mission of Public Health and are part of the Net County Cost of the Division.

Because of new equipment and the availability of new methodologies and reagents, the testing menu has expanded to include 38 new tests. New clinical tests include Norovirus, Influenza A, Methicillin-resistant Staphylococcus aureus (MRSA) and Quantiferon. New environmental tests include nitrate/nitrite and physical properties of water. Quantiferon is a remarkably improved laboratory test to detect infection with tuberculosis (TB), which we hope will eventually replace TB skin testing.

In November 2007 all primary customers were informed of the proposed fee increases. County Counsel has reviewed and approved the Resolution as to form.

FISCAL IMPACT

The proposed changes to the Public Health Laboratory fees are expected to generate new revenue of approximately $280,000 for FY 2008-09. This increase was anticipated and included in the Public Health FY 2008-09 Recommended Budget. The FY 2008-09 Recommended Budget Net County Cost for the Public Health Laboratory is $925,950.