Diabetes And The Fragmented State Of US Health Care And Policy

Puneet Kaur Chehal, Elizabeth Selvin, Jennifer E. Devoe, Carol M. Mangione, Mohammed K. Ali

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Progress in the prevention and treatment of type 2 diabetes— the dominant form of diabetes—appears to have stalled in the US over the past decade, and diabetes-related morbidity has increased nationally. The most geographically and socioeconomically disadvantaged segments of the population have been especially hard hit, and interventions that reduce the risk for diabetes have not reached these populations. In this overview article we lay out how fragmentation in health policy and governance, payers and reimbursement design, and service delivery in the US has contributed to low accountability and coordination, and thus stagnation and persistent inequities. We also review the evidence regarding past, ongoing, and new reforms that may help address fragmentation, lower diabetes burdens, and narrow disparities.

Original languageEnglish (US)
Pages (from-to)939-946
Number of pages8
JournalHealth Affairs
Issue number7
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Health Policy


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