Improving Diabetes Care: The Model for Health Care Reform

A s policy makers now debate the elements of health care reform, the medical management of diabetes is an excellent “case study” and in nearly all ways epitomizes the problems the country faces. The most obvious way in which diabetes epitomizes the need for health care reform is that chronic diseases, not acute infectious disorders, are the current and growing health-related financial drain on the country. Of the six leading causes of death in the U.S., four are chronic diseases (1). In 2005, 44% of adult Americans had at least one chronic condition, and diabetes (without complications), hypertension, and hyperlipidemia were the three most prevalent, accounting for 31% of all reported chronic disease (2). Coupling the current impact of chronic disease with the increases that are expected to occur (3), future health care spending for diabetes is likely to worsen. Lest one believe that the financial burden of health care does not reach the public directly, Emanuel and Fuchs (4) point out that government exacts its share through taxation or by reducing other services that benefit citizens. Employers pass on health care costs in the form of lower wages or higher prices. As for direct spending by the public, Paez et al. (2) reported that out-of-pocket health care spending from 1996 to 2005 rose 45% (adjusted for inflation and changing disease prevalence), with the greatest growth occurring in those with multiple chronic diseases, as seen in those with diabetes.