Diabetes in a Managed Care System

1 January 1996 | Volume 124 Issue 1 Part 2 | Pages 160-163

Health care expenditures account for over 14% of the gross domestic product in the United States.Managed care has evolved to control these costs. Because diabetes accounts for nearly 15% of health care expenditures, the strategies used by managed care organizations are expected to have a particular effect on diabetes. Managed care organizations have two primary goals: to control costs and to provide care of sufficient quality to attract and satisfy enrollees. Managed care organizations have designed strategies to meet these goals. Four primary managed care strategies and their effects on diabetes care are discussed: 1) payment incentives rewarding desired provider practice patterns; 2) designation of providers who possess desirable practice behaviors; 3) coverage policies that control the services paid for; and 4) traditional insurance strategies that determine who is eligible for insurance and what premiums are to be paid. The few direct studies of the effects of each strategy on the care of diabetic persons are discussed. The conclusion is that although managed care organizations have the potential to provide excellent care for diabetic persons, little evidence exists that they have improved either the quality or the cost-effectiveness of diabetes care. Recommendations to guide the development of cost-effective care for diabetic persons are presented.

Author and Article Information

From Joslin Diabetes Center, Inc., Boston, Massachusetts. For the current author address, see end of text.
Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled "Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference." To view a complete list of the articles included in this supplement, please view its Table of Contents.
Requests for Reprints: Kenneth E. Quickel Jr., MD, President, Joslin Diabetes Center, Inc., One Joslin Place, Boston, MA 02215.