[Choosing effective laboratory tests for diabetes care, and the reimbursement system]

Diabetes mellitus is a prototype chronic disease. The number of patients with diabetes in Japan is estimated to be about 6.9 million. Expenditure for diabetes care is increasing rapidly and this increase imposes a major economic burden. The Japanese Government has developed health-care payment policies designed to balance the growth of health-care expenditure against other national priorities. Often these policies tend to limit the various services. The Japan Diabetes Society(JDS) published management guidelines for diabetes for general practitioners in 1999. There is increasing concern about the cost of laboratory studies, including self-monitoring blood glucose(SMBG), as well as the cost of general diabetes care. The Japanese Society of Laboratory Medicine(JSLM) has also developed standards to choose effective laboratory tests for general practitioners. Health professionals must have a clear knowledge of the reimbursement system in order to understand the economic factors that control the services available to their patients. Ideally, however, the reimbursement system should meet the financial needs of the services necessary to conform to the professional consensus of the acceptable quality of care for people with diabetes.