The search for the best models of the laboratory service functioning is of particular importance under healthcare reorganization conditions. An experience and results of applying of the basic approaches to the microbiological service optimization are considered in this article. They include centralization of laboratory tests, a variety of costs reduction options on out- and intralaboratory stages at the facility and/or laboratory level, automating of preanalytical and analytical stages, and the introduction of point-of-care tests. At the same time, it is necessary to take into account the specific requirements for microbiological samples storage and transportation, expert interpretation of results, as well as high significance of the microbiological diagnosis in prevention of healthcare-associated infections. Foreign and Russian specialists experience demonstrates the need to assess the individual characteristics of the specific facility/region and to identify general hospital effects when the specific approach is implementing. This kind of the microbiological service effectiveness assessment is based not only on the particular tests costs, but primarily on the analysis of the length and the cost of hospitalization, antibiotic therapy duration and costs etc. The introduction of clinically and economically justified combination of the above mentioned approaches allows to reduce the costs of the microbiological service maintaining significantly, to shorten turnaround times, to standardize the processes at microbiological laboratories.