As employers, health care plans, and payers continue to search for ways to reduce costs and improve the value of health care benefits, attention has focused on opportunities to improve the outcomes and reduce the costs of chronic diseases. One of the most common, severe, and costly diseases today is diabetes mellitus. Direct medical costs for its treatment are estimated at 45 billion dollars, and the indirect cost of lost work days alone is estimated at over 47 billion dollars.i Yet, diabetics may work for years before they experience complications which cause them to take extended sick or disability leave, or to exit the workforce. During these years, they have been shown to have similar work attendance records to those without diabetes, but their productivity may be reduced if their diabetes is not controlled. If reduced on-the-job productivity were included in the estimate of indirect costs, it would likely be several billion dollars higher. Yet, because indirect costs are difficult to enumerate and only employers and patients have incentives to control them, health care plans have focused on only the direct costs of medical care. The primary issue is that strategies to minimize direct medical care costs may not minimize the total costs imposed by the disease (direct medical care costs plus the indirect costs of premature death, sick and disability leave, and lower productivity while on the job). Furthermore, productivity costs may be more sensitive to medical management than direct medical care costs. Total costs might be minimized by spending more on medical care to improve the health of patients and the productivity of organizations. In this prospective, controlled observational study, I will: (1) Measure the productivity of an employed diabetic population and a matched non- diabetic population in conjunction with a larger study, Work Site Disease Management (WiSDoM). (2) Test the construct validity of the productivity estimates generated by the survey instrument against a clinical measure of diabetic control and diabetes-specific functional status. (3) Compare the direct and indirect costs of each group. (4) Perform multiple regression analysis to determine the significance of having diabetes, the degree of diabetic control, and the importance of diabetic treatments such as diabetes education and home glucose monitoring on productivity and total costs (medical care plus indirect costs), controlling for variables such as personal crisis, job satisfaction, age, sex, and occupation.
