title: Impact of two different health systems on the burden of type 2 diabetes.
abstract: OBJECTIVE
  Health policy directs the management of patients with chronic disease in a country, but evaluating nationwide policies is difficult, not least because of the absence of suitable comparators. This paper examines the management of patients with type 2 diabetes in two demographically comparable populations with different health care systems to see if this represents a viable approach to evaluation.
  
  
  METHODS
  A secondary analysis of centralized prescribing databases for 2010 was undertaken to compare the levels and costs of care of patients with type 2 diabetes in Northern Ireland's National Health Service (NHS) (NI, n = 1.8 million) which has structured care, financial incentives related to diabetes care and an emphasis on generic prescribing, with that of the Republic of Ireland (ROI, n = 4.3 million) where management of diabetes care is guided solely by clinical and other guidelines.
  
  
  RESULTS
  The prevalence of treated type 2 diabetes was 3.59% in NI and 3.09% in ROI, but there were similar and high levels of prescribing of secondary cardiovascular medications. Medication costs per person for anti-diabetic, anti-obesity and cardiovascular medication were 46% higher in ROI than NI, due to differences in levels of generic prescribing.
  
  
  CONCLUSIONS
  These different health care systems appear to be producing similar levels of care for patients with type 2 diabetes, although at different levels of cost. The findings question the need for financial incentives in NI and highlight the large cost savings potentially accruing from a greater shift to generic prescribing in ROI. Cross-country comparison, though not without difficulties, may prove a useful adjunct to within-country analysis of policy impact.
authors.affiliation: Research Fellow, Centre of Excellence for Public Health, Queen's University Belfast, UK.
authors.forename: Naomh
authors.initials: N
authors.lastname: Gallagher
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Reilly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019440:Anti-Obesity Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D015995:Prevalence; D012052:Reimbursement, Incentive / Q000191:economics; D013222:State Medicine / Q000191:economics; D055815:Young Adult
chemical_list: D019440:Anti-Obesity Agents; D016568:Drugs, Generic; D007004:Hypoglycemic Agents
keywords: diabetes; evaluation; health policy; health system comparisons