Disease management: definitions, difficulties and future directions

The last decade has seen a wide range of experiments in health care reform intended to contain costs and promote effectiveness. In the USA, managed ca re and disease management have been major strategies in this endeavour. It has been argued that their apparent success has strong implications for ref orm in other countries. However, in this paper we ask whether they are so e asily exportable. We explain the concepts involved and set the development of managed care and disease management programmes in the context of the USA . The constituent elements of disease management are identified and discuss ed. Disease management is considered from the perspectives of the major sta keholders in the United Kingdom, and the differences between the models of health care in the United Kingdom's National Health Service and the USA are noted. A review is presented of evaluations of disease management programm es and of the weaknesses they highlight. The prospects for disease manageme nt in Europe are also discussed.