Managed care's clinical and economic impact on patients with type II diabetes in France: a controlled population-based study.
OBJECTIVE
The purpose of this paper is to assess the impact of five type II diabetes managed care programmes (MCPs) in clinical and economic terms at the community level in which these programmes function in the Provence-Alpes-Côte d'Azur region of France.


METHODS
A prospective, controlled, before-and-after study (2001-2004) compared diabetic patients who lived in departments (localities) with (the experimental group) and without a MCP (the control group). Quality of care was estimated by the conformity of health care professionals' practices when following-up type II diabetes. Costs are compared from a health service perspective.


RESULTS
The study finds that of 626 patients enrolled, 529 lived in departments with an MCP and 97 patients in departments without. Type II diabetes follow-up globally improved between the two study periods (2001 and 2004), but the study did not show significant differences between the two groups, except for the proportion of creatinine and ophthalmologic examinations, which were higher for the control group. The study did not find significant differences in the increase of costs between the two groups from 2001 to 2004.


CONCLUSIONS
This type of study could constitute a methodological model to assess the MCPs population impact.


CONCLUSIONS
MCPs probably did not reach a critical size in terms of patient recruitment and healthcare professional adhesion to have a significant impact at a population level.


CONCLUSIONS
The study highlights a number of points to consider for future MCPs in France.
Boyer
Laurent
L
Unité d'Evaluation Médicale, CHU Grenoble, Union Régionale des Caisses d'Assurance Maladie et Agence Régionale d'Hospitalisation de la Région Provence Alpes Côte d'Azur, Grenoble, France. laurentb_perso@hotmail.com
François
Patrice
P
Fourny
Magali
M
Ohrond
Céline
C
Chanut
Charles
C
Labarère
José
J
Auquier
Pascal
P
D000368:Aged; D001786:Blood Glucose; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*
D001786:Blood Glucose; D007004:Hypoglycemic Agents