ON THE AGENDA | SEPTEMBER 14TH, 2017 | Danielle Sang

How do you improve diabetes care? Ask a patient.

Health care providers may be the answer, in more ways than one, to improving high-quality care for diabetes patients.

Diabetes is a major public health problem in America, one that affects nearly 10 percent of the population or about 20 million people. This is one of several reasons Public Agenda chose diabetes, specifically type 2, as one of the three particular care situations to examine in new research that looks at how people think about high-quality care.

Diabetes requires constant care. Self-management and a sustained relationship with a medical professional to monitor symptoms and complications are the ideal standard care procedures. But one has to ask themselves: What are the qualities diabetes care patients look for in their doctor? Do they prioritize certain qualities over others? Are patients receiving the care and information they need to adequately manage their health situation?

We set out to explore these among other questions in our research. When it comes to assessing high-quality care, we found research participants in the diabetes group valued doctorsí interpersonal skills over clinical qualities.

This finding becomes even more relevant when you consider the fact that effective management of diabetes requires sustained care with a medical provider. This may suggest that interpersonal skills from a medical provider is critical to proper diabetes care. Without this, rates of negative health outcomes such as heart attacks, strokes, kidney disease, and eye and nerve damage, can increase. This is especially true for black, Hispanic and lower-income people, who tend to have higher rates of complications.

Along with health costs on patients, diabetes also has a high monetary cost. In 2012, the United States spent $176 billion on diabetes. Given the high costs associated with diabetes care, itís important to note that our research found 31 percent of participants in the diabetes group were unaware doctorsí prices for care vary, while even more were unsure.

A Health Affairs study on price found patients who chose low-price physicians also gained savings in the long term on other medical services, such as lab tests, and had less annual out-of-pocket spending. With its high financial implications, even for those with employer-sponsored insurance, it may be helpful for diabetes patients to know how much one doctor charges for the same services versus another, in addition to weighing interpersonal qualities. Having knowledge on price variance may also be helpful in controlling costs, especially since our research found that, in the diabetes group, most say high prices are not a sign of better-quality care.

Type 2 diabetes affects approximately 9.3 percent of Americans. Blacks, Hispanics, Native Americans and those with less education are disproportionately affected at a rate of 13 percent. Diabetes affects all demographics and will continue to be an issue if not addressed and managed properly. Due to its chronic nature, self-care and working with a trusted provider are key elements for managing diabetes. As our research has found, while a high price may not be seen by those in the diabetes group as the equivalent of high-quality care, the answer to what is may lie in the hands of physicians. With the ability and knowledge to provide guidance on self-management, by referring patients to supplemental care managers such as lifestyle coaches or Certified Diabetes Educators, and by being a listening ear to medical concerns, health care providers may be the answer, in more ways than one, to improving high-quality care for diabetes patients.


Transparency in Health Care

Submitted by: GulfTrout on Wednesday, September 20th, 2017

Across all of these groups, fewer people knew or attempted to find out whether or not doctors or clinics had the qualities those people thought were important. About one-half of these people stated there was enough research about quality out there and less than about one-half stated there was enough information regarding price. Additionally, according to demographic studies, certain minority groups and less-educated people are more affected by these ailments and their ability to research information.
Policy-makers (such as Congressional representatives) should take from this data that providing a user-friendly way of helping people research the quality of doctors, hospitals, and clinics according to their needs with pricing would help, not only the people, but their political favor as well. And, health care should be a major area of focus for closing the electronic divide that exists between minorities and the less-educated and the more affluent members of our society.
By looking at the subject matters and responses in each strategy, policies could be formulated based on important aspects of each. For instance, combining how doctors are paid, price transparency, and performance-based payment for physicians, policy could be developed for emergency rooms and other hospital sections to offer to provide costs up front to patients prior to admission and simplify the payment method. Perhaps hospitals and related care facilities could find out the patientís insurance coverage acceptances for each of the doctors working in the ERs, like any doctorís office would do.
The public, including my family and friends, are well aware of the lack of transparency in health care (especially regarding cost). They continue through life accepting the problems this causes. Problems include the hours of time with frustration dealing with insurance, medical bills, and even attorneys, and needlessly spending money. Perhaps the public could urge policy-makers to enforce this transparency by health-care facilities in a competitive and economic manner.

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