U.S. veterans care beats managed care in diabetes

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Veterans with diabetes get better care under the Department of Veterans Affairs system than some patients using managed care, U.S. researchers reported on Monday and suggested nationalized health care can work well.

The study, published in the Annals of Internal Medicine, shows VA patients got the recommended care more often.

The study suggests that nationalized health care can work, the team at the University of Michigan and University of California said. 

"A nationally funded health care system can provide excellent quality of care,” Dr. Eve Kerr, of the VA Ann Arbor Healthcare System and assistant professor of internal medicine at the University of Michigan Medical School, said in a statement.

“The VA has instituted system-wide standards, integrated care, and a way to track and monitor how their patients are doing. Other organizations can learn from the VA and how they achieved their quality improvements over the last 10 years,” she added.

Her team studied 1,285 patients with diabetes treated at five VA medical centers and 6,920 patients in eight commercial managed care health plans.

They looked at whether patients received seven standard recommended tests or services - an eye exam, a measure of glucose control called the hemoglobin A1c test, cholesterol screening, a foot exam, urine analysis, advice on aspirin use and a flu vaccine.

Researchers also checked blood pressure and cholesterol.

They found that 93 percent of VA patients had an annual hemoglobin A1c test, compared to 83 percent of managed care patients, and 75 percent of VA patients were told about how aspirin can prevent heart attack and stroke, compared to 49 percent of managed care patients.

They found that 91 percent of VA patients had an annual eye exam compared to 75 percent of managed care patients. Diabetes can lead to blindness.

Beginning in 1995, the VA began improvements focused on managing chronic diseases such as diabetes.

The researchers say the investments paid off.

“However, we still need to learn more about which of the many changes the VA instituted improve quality the most, so that managed care health plans can implement these in the most cost effective manner,” added Dr. Carol Mangione of the University of California Los Angeles, who worked on the study.

SOURCE: Annals of Internal Medicine, August 17, 2004.

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