Likely to grow as pressure to deliver cost effective care mounts

Can healthcare providers improve the cost effectiveness of patient care by contracting out chunks to pharmaceutical companies? The evidence is equivocal, but the experiment is under way as drug companies move into chronic disease management.

The theory is as follows. Systematic, integrated, evidence based, long term care of populations of patients with chronic, high cost diseases such as asthma, back pain, rheumatoid arthritis, dementia, and diabetes is more effective than episodic fragmented care of individuals. The incidence of acute episodes and complications associated with disease is reduced and quality of life improves.1 Better health outcomes reduce costs. Setting up “disease management” programmes that operate across the boundaries of primary, secondary, and community care requires high capital investment and state of the art information technology. Few health care providers can readily supply these. Pharmaceutical industries can. Hence the logic of contracting out services or setting up joint ventures.

The difference between shared care (as, for example, in diabetes and asthma in Britain), …