Disease management in the American market

doi:10.1136/bmj.320.7234.563

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Thomas Bodenheime, clinical professor (tbodie@earthlink.net)

Department of Family and Community Medicine, University of California at San Francisco, School of Medicine, 1580 Valencia Street, Suite 201, San Francisco, CA 94110, USA

In developed nations, the care of people with chronic disease consumes a large portion of the total expenditure on health. Yet chronic disease is often poorly treated and inadequately prevented. Disease management was introduced in the 1990s as an attempt to improve the quality and reduce the cost of caring for people with chronic disease. The peculiar configuration of disease management programmes in the United States may provide lessons for countries seeking solutions to the problem of caring for patients with chronic disease.

Summary points

The goal of disease management programmes is to improve the quality and reduce the cost of caring for patients with chronic disease

Many disease management programmes in the United States are run by commercial firms that sell their programmes to employers, health maintenance organisations, and hospitals

Some disease management programmes cut costs and improve outcomes, however the data are not conclusive for the disease management movement in general

Commercial disease management programmes may take needed money away from actual caregiving in order to enhance companies' profits

Disease management should be performed within healthcare institutions and be integrated with primary care rather than being outsourced to specialised commercial entities

Methods

This article is based on a Medline search using the term “disease management,” review of websites run by companies engaged in running disease management programmes, and 20 interviews with experts and company executives who work in disease management.

Why disease management?

Over the past quarter century, the United States has searched for ways to control the growth of healthcare costs. Rather than rely on governmental regulation, the United States has chosen to use the private marketplace as an instrument of cost cutting.

In the 1980s, the vehicle chosen by large employers and the federal and state governments to control costs was the health maintenance organisation.1 Many entrepreneurs interested in making profits …