Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2012 Nov;111(11):605-16. doi: 10.1016/j.jfma.2012.09.011. Epub 2012 Oct 31.
BACKGROUND/PURPOSE: The prevalence of diabetes has increased worldwide. To obtain nationwide data on accountability and utilization of health resources among diabetes patients in Taiwan, an analysis of the claims data for the National Health Insurance (NHI) from 2000 to 2009 was conducted.
One-third of the NHI claims database was randomly sampled from 2000 to 2009. Diabetes was defined by three or more outpatient visits with diagnostic codes [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 250 or A code: A181] within 1 year, or one inpatient discharge diagnosis. Accountability items and NHI codes of various metabolic parameters and examinations were identified. Medical utilization was measured by the frequency and cost of care associated with ambulatory visits, hospitalizations, and emergency care within each year.
The annual check-up frequency for various examinations significantly increased from 2000 to 2009. Both the average outpatient department (OPD) cost per diabetes patient/year and the average inpatient department (IPD) cost per time increased 1.34-fold in the past decade. The average OPD cost per diabetes patient and average IPD cost of each admission for diabetes patients was four times and 1.4 times compare with the general population, respectively. The annual average medical cost of each diabetes patient affected with both micro- and macrovascular complications was four times compared with those without vascular complications. There was an increasing trend for diabetes patients to visit regional hospital for OPD and IPD, whereas visits to the local hospital decreased in the past decade.
Due to the increased frequency of annual check-ups after various examinations, the quality of diabetes management has improved in the past decade in Taiwan. As diabetes patients affected with both micro- and macrovascular complications incurred costs four times compared with those without complications, it is worth screening high-risk individuals to ensure earlier intervention and thus reduce diabetic complications and healthcare expenditure.
背景/目的：糖尿病的患病率在全球范围内有所增加。为了获得台湾糖尿病患者在健康资源利用和责任方面的全国性数据，我们对 2000 年至 2009 年的全民健康保险（NHI）理赔数据进行了分析。
从 2000 年至 2009 年，NHI 理赔数据库的三分之一被随机抽取。糖尿病的定义为在一年内有三次或以上的门诊就诊记录，且有诊断代码[国际疾病分类，第 9 次修订版，临床修正（ICD-9-CM）：250 或 A 代码：A181]，或一次住院诊断。确定了各种代谢参数和检查的责任项目和 NHI 代码。通过每年与门诊、住院和急诊相关的护理频率和费用来衡量医疗利用率。
各种检查的年度检查频率从 2000 年到 2009 年显著增加。过去十年中，每位糖尿病患者的平均门诊（OPD）费用/年和每次住院时间的平均住院部（IPD）费用增加了 1.34 倍。糖尿病患者的平均 OPD 费用和每次住院的平均 IPD 费用分别是普通人群的四倍和 1.4 倍。患有微血管和大血管并发症的糖尿病患者的年平均医疗费用是没有血管并发症的患者的四倍。糖尿病患者到区域医院进行 OPD 和 IPD 的就诊次数呈上升趋势，而过去十年中，他们到当地医院就诊的次数有所减少。
由于各种检查后的年度检查频率增加，过去十年中台湾的糖尿病管理质量有所提高。由于患有微血管和大血管并发症的糖尿病患者的费用是没有并发症的患者的四倍，因此值得对高危人群进行筛查，以确保及早干预，从而减少糖尿病并发症和医疗保健支出。
