Underinvesting in Prevention: The Costly Blind Spot in U.S. Diabetes Care

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ID: 321561
2026
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Abstract
Abstract To address the systemic financial and equity burdens of preventable diabetes-related lower-extremity amputations, this perspective evaluates current structural failures in U.S. health care financing and proposes a scalable, prevention-oriented framework. Current fee-for-service models consistently reimburse expensive disease deterioration while neglecting early surveillance. Meanwhile, omitting preventive foot metrics from federal quality frameworks renders early intervention organizationally invisible. In response, this analysis incorporates data from a peer-reviewed, five-year implementation study within a medically complex population using low-overhead, multilingual, digital patient education and risk-stratified surveillance. This low-friction intervention model achieved a diabetic foot ulcer rate of 2.8% and a major amputation rate of 0.43%, significantly outperforming the federal Healthy People 2030 benchmark of 0.55%. To replicate these results nationally, public payers must integrate risk-stratified podiatric surveillance into core quality reporting frameworks, expand reimbursement codes for asynchronous digital education, and formally classify patient-centered education as vital health infrastructure. Such policy prioritization will mitigate profound health disparities, reduce avoidable public spending, and preserve patient mobility.
Reference Key
openalex_W7169680388 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Paul Y. Han
Journal Health Affairs Scholar
Year 2026
DOI
10.1093/haschl/qxag190
URL
https://doi.org/10.1093/haschl/qxag190
Keywords Keywords not found

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