well-coordinated public health system for the detection and control of emerging infections and antimicrobial resistance requires an effective partnership among health care providers, academic health centers, and the traditional public health system. Effective infectious disease surveillance necessitates that physicians send samples to competent laboratories for confirmation of their diagnoses and that they report the findings through the public health system. Yet, each aspect of infectious disease surveillance is evolving independently and rapidly.
Cost-reduction and reimbursement efforts through managed care emphasize the heavy reliance on empiric care rather than laboratory data. This reduces the use of diagnostic tests, discourages visits to specialists, and shifts care to ambulatory settings, where the capabilities for diagnosis and care are less than those found at inpatient facilities. Yet, standard types of managed care organizations, such as the staff model and preferred provider health maintenance organizations (HMOs), are being bypassed by some large payers in favor of the direct purchase of services from individual physicians and small laboratorie