Managed and Protocolized Care for Type 2 Diabetes Patients in Primary Care. an Analysis of Resource Use and Costs

Aims: To evaluate the care process and costs of managed, protocolized, and usual care for type 2 diabetes patients from a societal perspective. Methods: In two distinct regions of the Netherlands, managed and protocolized diabetes care were implemented. Managed care was characterized by a central organization, coordination, responsibility and central annual assessment. Protocolized care had a partly centralized organization structure. Usual care was characterized by a decentralized organization structure. The care process (guidelines adherence) and costs were compared between managed (n=253), protocolized (n=197), and usual care (n=333). Results: Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI:-2.597 to-334)) while indirect costs were higher (€758 (95% CI:-353 to 2.701), direct, indirect and total costs were (non-significantly) lower in protocolized care. Conclusions: Compared to usual care, managed care was significantly associated with a better process of the diabetes care, less consultations in secondary care and lower health care costs. Same trends were seen for protocolized care, however not significant.