Abstract
BackgroundThe Austrian diabetes disease management program (DMP) was introduced in 2007 in order to improve health care delivery for diabetics via the promotion of treatment according to guidelines. Considering the current low participation rates in the DMP and the question of further promotion of the program, it is of particular interest for health insurance providers in Austria to assess whether enrollment in the DMP leads to differences in the pattern of the provision of in- and outpatient services, as well as to the subsequent costs in order to determine overall program efficiency.MethodsHistoric cohort study comparing average annual levels of in- and outpatient health services utilization and its associated costs for patients enrolled and not enrolled in the DMP before (2006) and 2 years after (2009) the implementation of the program in Austria. Data on the use of services and data on costs were extracted from the records of the Austrian Social Insurance Institution for Business. 12,199 persons were identified as diabetes patients treated with anti-diabetic medication or anti-diabetics with insulin throughout the study period. 314 diabetics were enrolled in the DMP.ResultsPatients enrolled in the diabetes DMP received a more evolved pattern of outpatient care, featuring higher numbers of services provided by general practitioners and specialists (79 vs. 62), more diagnostic services (22 vs. 15) as well as more services provided by outpatient care centers (9 vs. 6) in line with increased levels of participation in medical assessments as recommended by the treatment guideline in 2009. Hospitalization was lower for DMP patients spending 3.75 days in hospital, as compared to 6.03 days for diabetes patients in regular treatment. Overall, increases in costs of care and medication throughout the study period were lower for enrolled patients (€ 718 vs. € 1.684), resulting in overall costs of € 5,393 p.c. for DMP patients and € 6,416 p.c. for the control group in 2009.ConclusionsSeen from a health insurance provider’s perspective, the assessment of the Austrian diabetes DMP shows promising results indicating improved quality of outpatient care as well as overall cost advantages due to the lower hospitalization rates. Due to methodological limitations of the retrospective study and to the restricted data access, further promotion of the DMP must be accompanied by prospective research and preferably controlled trials in order to provide a solid basis for the decision of whether to include diabetes DMP into the insurer’s basic benefit package.
Highlights
The Austrian diabetes disease management program (DMP) was introduced in 2007 in order to improve health care delivery for diabetics via the promotion of treatment according to guidelines
Due to the fact that enrollment onto the Austrian diabetes DMP was not possible before the beginning of 2007, only this subgroup of 14,408 patients was included in the subsequent analysis as figures for 2006 would reflect baseline values in order to assess the impact of participation
Analyzing the mere structure of the different outpatient services as presented in Table 2, it becomes clear that increased costs for outpatient care for the DMP group are mainly due to the higher share of enrolled patients receiving specific diagnostic services according to the treatment guidelines as opposed to the group of non-participating patients and is in line with the intention of disease management
Summary
The Austrian diabetes disease management program (DMP) was introduced in 2007 in order to improve health care delivery for diabetics via the promotion of treatment according to guidelines. Considering the current low participation rates in the DMP and the question of further promotion of the program, it is of particular interest for health insurance providers in Austria to assess whether enrollment in the DMP leads to differences in the pattern of the provision of in- and outpatient services, as well as to the subsequent costs in order to determine overall program efficiency. As the treatment of (severe) diabetes usually involves lifelong therapy with anti-diabetic medication and/or the injection of insulin as well as regular monitoring of the patients’ health status and subsequent patient involvement, diabetes disease management programs (DMPs) have been developed in most health systems of industrialized countries. Building on the standardization of treatment pathway as well as the implementation of treatment guidelines, DMPs are intended to lead to coordinated or even integrated health care delivery and better health outcomes for participating individuals at reasonable additional or even lower costs [13]
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