Diabetes care in health maintenance organizations

An increasing amount of health care today is directed to the amelioration of chronic diseases for which there are no cures. Technological advances and the aging of the population have increased the costs of that care. In an attempt to control costs and increase the efficiency of health care, it is being increasingly delivered in alternate health-care systems where third-party payors influence the access, use, and quality of that care. This article traces the history of the development of alternative health-care delivery systems and describes how they attempt to deal with the tension between cost and quality in the context of the delivery of health care to people with diabetes. Systems for home health care, health education and dietary counseling, prescriptions and durable medical equipment, medical technology assessment, quality management, peer review, and cost containment in the various alternative health-care settings are described. Theoretically, the health maintenance organization offers an ideal system for delivering care that is accessible, affordable, and of good quality.