For assessment of health-care charges generated by patients with diabetes, 50 patients (25 who were older than 65 years and 25 who were age 65 or younger) whose primary care had been delivered between 1990 and 1995 by a single diabetologist were randomly selected. Institutional health-care bills were accessed from all but three medical center billing offices (dermatology, psychiatry, and radiation oncology areas did not respond). For each dollar billed by endocrinology, the hospital billed 25.90 dollars, other medical specialties 2.70 dollars, surgery 1.10 dollars, radiology 0.70 dollars and pathology 0.60 dollars. The charges generated by the endocrinologist-diabetologist account for approximately 3% of the total charges for the care of the patient with diabetes mellitus in a fee-for-service practice. Although the endocrinologist-diabetologist provides the most cost-effective medical service for patients with diabetes, low reimbursement jeopardizes the practice of this subspecialty.
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