Effects of a population-based diabetes management program in Singapore

We evaluated the impact of Singapore's Medisave for Chronic Disease Management Program (CDMP) program for type 2 diabetes mellitus (T2DM) patients.

A longitudinal study comparing differences in compliance with recommended diabetes care processes and management strategies, hospitalization, and costs among the Medisave for CDMP participants and propensity-matched nonparticipants.

Data on patients diagnosed with T2DM who participated in the Medisave for CDMP (n = 10,559) and eligible patients who did not participate (n = 22,089) were extracted from the National Healthcare Group (NHG) diabetes registry. Participants and nonparticipants were propensity-score matched. Processes of care, all-cause and diabetes-related hospitalization risk, and healthcare costs incurred in 2007, 2008, and 2009 were compared between groups. A difference-in-difference strategy and generalized estimating equation approach were used.

Compliance with recommended processes of care improved significantly for program patients. Compared to nonparticipants, all-cause hospitalization risk for participants was significantly lower in 2007 (odds ratio [OR]: 0.76; 95% CI, 0.65-0.88) and 2008 (OR: 0.79; 95% CI, 0.68-0.92) but the difference was not statistically significant in 2009 (OR: 0.91; 95% CI, 0.79-1.05). Total healthcare cost was 14-15% lower for participants in 2007 and 2008 but not significantly different in 2009. Similar results were observed for diabetes-related hospitalization rates and inpatient costs. The policy did not have a significant impact on participants with wellcontrolled diabetes at baseline.

The extension of Medisave coverage to outpatient treatment increased the compliance with the processes of diabetes care. The policy reduced hospitalization risk and total healthcare cost in the short term but effects were not sustained by the third year.