title: The upside down world of diabetes care medical economics and what we might do to improve it.
abstract: OBJECTIVE
  Increasingly over the past generation, the American healthcare delivery system has received consistently poor marks with regard to public health outcomes and costs. This review by two seasoned diabetes care providers is intended to shed light on the fundamental flaws we believe to underlie that poor performance, and suggest options for better outcomes and cost efficiencies.
  
  
  RESULTS
  Despite major advances in diabetes management medications and tools, overall public health with regard to diabetes outcomes remains poor. Efforts focused on controlling costs appear to be exacerbating the problem.
  
  
  CONCLUSIONS
  For chronic diseases like diabetes, fee-for-service care models are fundamentally flawed and predictably fail. We suggest that a major overhaul of the medical economics underlying diabetes care can improve patient outcomes and decrease costs.
authors.affiliation: aDepartment of Medicine, Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, Massachusetts bDepartment of Medicine, Division of Metabolism, Endocrinology, and Nutrition at the University of Washington Medical School, Seattle, Washington, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Harlan
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
mesh_terms: D002908:Chronic Disease; D003695:Delivery of Health Care / Q000191:economics*; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D004470:Economics, Medical; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D058996:Quality Improvement / Q000191:economics*; D014481:United States / Q000453:epidemiology