Buescher Paul A, Whitmire J Timothy, Pullen-Smith Barbara
State Center for Health Statistics, North Carolina Division of Public Health, USA.
N C Med J. 2010 Jul-Aug;71(4):319-24.
Health disparities for many diseases are large and long-standing in North Carolina and the nation. This study examines medical care costs for diabetes associated with health disparities among adults (age, > or =78 years) enrolled in Medicaid in North Carolina during state fiscal year (SFY) 2007-2008 (i.e., July 7, 2007, through June 30, 2008).
North Carolina Medicaid paid claims and enrollment data were used to calculate the prevalence of and medical care expenditures for diabetes among adult Medicaid enrollees overall and by white, African American, and American Indian race. The impacts of racial and economic health disparities on medical care costs for diabetes were determined by first calculating the proportionate differences between the diabetes prevalence for whites, African Americans, and American Indians enrolled in Medicaid and the diabetes prevalence among all whites in North Carolina. Then it was assumed that medical care costs for white, African American, and American Indian Medicaid recipients could be reduced by the same proportion if the overall prevalence among whites was achieved.
The diabetes prevalence among adult Medicaid enrollees was 75.7%, compared with 9.1% for all North Carolina adults. During SFY 2007-2008, the state Medicaid program in North Carolina spent $525 million for diabetes-related medical care and prescription drugs among adults. An estimated $225 million in diabetes-related expenditures could be saved each year by the North Carolina Medicaid program if both racial and economic disparities in the diabetes prevalence were eliminated.
We did not have data on non-Medicaid paid health care expenditures for the Medicaid enrollees in our study. The costs of interventions to eliminate health disparities associated with diabetes are not included in the calculation of the potential savings.
The diabetes prevalence in the Medicaid population is much greater than that for all North Carolinians, and the Medicaid costs associated with this elevated prevalence are large. North Carolina health-policy makers and health-program managers should carefully evaluate investments in interventions to reduce these race- and economic-based differences in diabetes prevalence, which could potentially reduce Medicaid costs.
在北卡罗来纳州乃至全国，许多疾病的健康差距巨大且长期存在。本研究调查了2007 - 2008年州财政年度（即2007年7月7日至2008年6月30日）期间，北卡罗来纳州参加医疗补助计划的成年人（年龄≥78岁）中与健康差距相关的糖尿病医疗费用。
利用北卡罗来纳州医疗补助计划支付的索赔和参保数据，计算成年医疗补助参保者总体以及按白人、非裔美国人和美国印第安人种族划分的糖尿病患病率和医疗支出。种族和经济健康差距对糖尿病医疗费用的影响首先通过计算参加医疗补助计划的白人、非裔美国人和美国印第安人的糖尿病患病率与北卡罗来纳州所有白人的糖尿病患病率之间的比例差异来确定。然后假设，如果能达到白人的总体患病率，白人、非裔美国人和美国印第安医疗补助受助者的医疗费用可以按相同比例降低。
成年医疗补助参保者的糖尿病患病率为75.7%，而北卡罗来纳州所有成年人的患病率为9.1%。在2007 - 2008年州财政年度期间，北卡罗来纳州的州医疗补助计划在成年人中为糖尿病相关医疗和处方药支出了5.25亿美元。如果消除糖尿病患病率方面的种族和经济差距，北卡罗来纳州医疗补助计划每年估计可节省2.25亿美元与糖尿病相关的支出。
我们没有关于本研究中医疗补助参保者非医疗补助支付的医疗保健支出的数据。消除与糖尿病相关的健康差距的干预措施成本未包含在潜在节省费用的计算中。
医疗补助人群中的糖尿病患病率远高于所有北卡罗来纳州居民，与这种较高患病率相关的医疗补助费用很高。北卡罗来纳州的卫生政策制定者和卫生项目管理者应仔细评估为减少这些基于种族和经济的糖尿病患病率差异而进行的干预措施投资，这有可能降低医疗补助费用。
