Harlan David M, Hirsch Irl B
aDepartment of Medicine, Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, Massachusetts bDepartment of Medicine, Division of Metabolism, Endocrinology, and Nutrition at the University of Washington Medical School, Seattle, Washington, USA.
Curr Opin Endocrinol Diabetes Obes. 2017 Apr;24(2):112-118. doi: 10.1097/MED.0000000000000325.
Increasingly over the past generation, the American healthcare delivery system has received consistently poor marks with regard to public health outcomes and costs. This review by two seasoned diabetes care providers is intended to shed light on the fundamental flaws we believe to underlie that poor performance, and suggest options for better outcomes and cost efficiencies.
Despite major advances in diabetes management medications and tools, overall public health with regard to diabetes outcomes remains poor. Efforts focused on controlling costs appear to be exacerbating the problem.
For chronic diseases like diabetes, fee-for-service care models are fundamentally flawed and predictably fail. We suggest that a major overhaul of the medical economics underlying diabetes care can improve patient outcomes and decrease costs.
在过去一代人的时间里，美国医疗保健服务系统在公共卫生成果和成本方面一直得到差评。两位经验丰富的糖尿病护理提供者进行的这项综述旨在揭示我们认为导致该系统表现不佳的根本缺陷，并提出改善结果和提高成本效益的选择方案。
尽管糖尿病管理药物和工具取得了重大进展，但糖尿病方面的总体公共卫生状况仍然不佳。专注于控制成本的努力似乎正在使问题恶化。
对于糖尿病等慢性病，按服务收费的护理模式存在根本缺陷且注定会失败。我们建议对糖尿病护理的医学经济学进行重大改革，以改善患者预后并降低成本。
