Researcher: Cost, Quality Key To Diabetes Care

There's an age-old question that plagues our nation’s changing health care system: Are higher health care costs  for patients always associated with higher quality goods and services?

University of South Florida College of Public Health researcher  Troy Quast 's work, took on that question, as it pertained to one of the most significant diseases affecting Americans: diabetes. 

His article, " Quality of Care and Relative Resource Use for Patients with Diabetes,” was published in the June issue of the American Journal of Managed Care.

Quast looked at diabetics who had commercial insurance plans between 2009 and 2011. Earlier papers suggested higher-cost plans didn't necessarily offer higher quality care.

"But one of the nicer things about the data set that I used is that I was able to look at certain types of care," Quast said. "For me, the most interesting results were looking at the relationship between costs for in-patient care, individuals are admitted to hospitals, and the quality of care they receive, and I found that there's a pretty strong negative relationship generally for those types of care."

On the other hand, "outpatient and ambulatory pharmacy  measures, those typically had a positive relationship, somewhat indicating that more utilization of those resources led to better outcomes for those individuals," he added.

Other studies have posted similar findings. Express Scripts recently looked at spending on drugs for different diseases, while the Health Care Cost Institute examined per capita health care spending, and in both cases, people with diabetes paid more for healthcare than people without it.

"I believe that (my) findings where you could see the pharmacy cost utilization - the more medicine is used - that leads to typically better outcomes," Quast said. "So I think those (other studies) are somewhat consistent with my findings in that the higher the resource utilization for medicine, perhaps the better outcome for these diabetes patients, because the one outcome we want to avoid are in-patient admissions for a diabetic situation, so they're able to control their condition with medicine that can lead to not only better outcomes but also lower costs for the insurance plans."

And, while Quast's study didn't address the issue directly, there are also questions about access to healthcare.

"Unfortunately in the U.S., too many people have to go to the emergency room to treat conditions that weren't treated initially, so diabetes is a prime example of that where, if individuals can get the care that they need - make sure they're on a diet, get the proper medications - they would avoid a lot of the high-cost emergency room visits," Quast said.

"The more we can help individuals develop that relationship (with) a primary care provider, the more we can hopefully improve outcomes and reduce costs, which are both great...for our system."

For more on Quast's research, see: “ Diabetes Care Provided to Children Displaced by Hurricane Katrina,” published in the Disaster Medicine and Public Health Preparedness August issue.

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