Diabetes in a Managed Care System

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 ac-counts for nearly 15 % of health care expenditures, the strategies used by managed care organizations are ex-pected 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 de-signed strategies to meet these goals. Four primary man-aged care strategies and their effects on diabetes care are discussed: 1) payment incentives rewarding desired pro-vider practice patterns; 2) designation of providers who possess desirable practice behaviors; 3) coverage policies that control the services paid for; and 4) traditional insur-ance strategies that determine who is eligible for insur-ance and what premiums are to be paid. The few direct studies of the effects of each strategy on the care of dia-betic persons are discussed. The conclusion is that although managed care organizations have the potential to pro-vide 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