Effects of cost containment on the care of elderly diabetics.
OBJECTIVE
Because of rising costs in the Medicare program, the elderly have been encouraged to enroll in health maintenance organizations (HMOs). To evaluate the quality of care in these HMOs, detailed criteria on the treatment of elderly diabetics were established by an expert panel.


METHODS
Approximately 20 months of care for elderly diabetics was reviewed by medical record abstractions with a historical cohort design.


METHODS
The care of elderly diabetics in eight HMOs was compared with the care received in fee-for-service (FFS) settings located in similar geographic areas.


METHODS
Elderly diabetics enrolled in HMOs (n = 158) were compared with similar diabetics (n = 134) in FFS settings.


RESULTS
Diabetic HMO enrollees were more likely to have funduscopic examinations (48% in HMOs vs 30% FFS) and urinalyses (89% in HMOs vs 74% FFS) performed. Enrollees with poor diabetic control were also more likely than FFS diabetics to be referred to an ophthalmologist (45% in HMOs vs 11% FFS). However, influenza vaccinations were administered to diabetics more often in FFS settings than to diabetic enrollees (19% in HMOs vs 62% FFS). One fifth of diabetics in both groups were treated with insulin and two thirds were treated with oral hypoglycemic agents, though HMO enrollees were more likely to have medication changes.


CONCLUSIONS
We conclude that most aspects of the quality of diabetic care were similar in HMO and FFS settings and were unaffected by this effort at cost containment.
Retchin
S M
SM
Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Preston
J
J
D000368:Aged; D003363:Cost Control; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D005251:Fees, Medical; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care / Q000191:economics*; D014481:United States