The notion that it's in society's best interest to help people avoid diabetes and its debilitating, costly complications is muddied by America's fragmented healthcare system.
From the point of view of a health insurance industry bean counter, the business case for diabetes management is weak.
For The Record
Los Angeles Times Friday May 11, 2007 Home Edition Main News Part A Page 2 National Desk 1 inches; 39 words Type of Material: Correction
Diabetes: In Monday's Health section, an article on diabetes care stated that Integrated Healthcare Assn. offers an incentive for good diabetes care. In fact, the organization coordinates the payout program, but the individual insurance company members pay the incentive.
For The Record
Los Angeles Times Monday May 14, 2007 Home Edition Health Part F Page 11 Features Desk 1 inches; 38 words Type of Material: Correction
Diabetes: A May 7 Health article on diabetes care said that Integrated Healthcare Assn. offered an incentive for good diabetes care. In fact, the organization coordinates the payout program, but the individual insurance company members pay the incentive.
Understanding why requires putting some statistics together.
There's no doubt that, without better efforts at preventing and controlling diabetes, medical costs will soar. Over the next 30 years, the epidemic will lead to 35 million heart attacks, 13 million strokes, 6 million episodes of kidney failure, 8 million people needing eye surgery or going blind, 2 million amputations and 62 million early deaths, according to a study by the American Diabetes Assn. and a consulting company, Archimedes Inc. The costs could total $6.6 trillion.
The study also found that if 80% of people with diabetes stopped smoking, controlled their blood pressure, cholesterol and blood glucose, took a baby aspirin a day and lost weight, complications would fall, saving about $150 billion over 30 years.
"I think if our society as a whole decided to focus more on health promotion and disease prevention, in the long term you would see substantial savings to the health system," says Dr. Anthony Shih, senior program officer at the Commonwealth Fund, an independent healthcare research foundation.
But much of America's healthcare industry operates on the economic short term. Many healthcare experts used to think that preventive care would save money -- which is the case for diseases such as asthma, where such care can quickly cut costs by reducing emergency room care and hospitalizations.
But for diabetes, the upfront efforts to avoid complications often don't pay off for decades.
One analysis, published in 2003 in the journal Health Affairs, looked at two groups, HealthPartners in Minneapolis and Independent Health Plan in Buffalo, N.Y., each with an intensive diabetes management program.
Researchers found that the two programs resulted in lowered hospitalizations and complications, ultimately saving $75 per patient after 10 years. But saving that money cost a lot at first -- an average of $330 per patient over the decade. The payoff didn't come until the very end.
During the 10th year, managing the disease saved $1,500 per patient, and savings were expected to continue.
