2型糖尿病患者医疗服务利用及费用的趋势和相关因素：一项全民健康保险计划的十年经验

Trend and factors associated with healthcare use and costs in type 2 diabetes mellitus: a decade experience of a universal health insurance program.

作者信息

Cheng Jur-Shan, Tsai Wen-Chen, Lin Chen-Li, Chen Likwang, Lang Hui-Chu, Hsieh Hui-Min, Shin Shyi-Jang, Chen Ted, Huang Chi-Ting, Hsu Chih-Cheng

机构信息

*Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan †Department of Health Services Administration, China Medical University, Taichung ‡Taipei City Hospital Fuyou Branch, Taipei §Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County ∥Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei ¶Department of Public Health, Kaohsiung Medical University, Kaohsiung #Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan **Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.

出版信息

Med Care. 2015 Feb;53(2):116-24. doi: 10.1097/MLR.0000000000000288.

DOI:10.1097/MLR.0000000000000288

PMID:25517075

Abstract

BACKGROUND

Little is known about how a universal National Health Insurance program with cost-containment strategies affect costs and quality of diabetes care.

OBJECTIVES

To examine the trends of healthcare use and costs for patients with type 2 diabetes mellitus (T2DM) in Taiwan over the last decade, and to identify factors associated with high healthcare cost and poor diabetes care.

RESEARCH DESIGN

We delineated the pattern of healthcare use and costs for T2DM in 2000-2010. Generalized linear and logistic regression models were used to identify factors associated with medical costs and diabetes care.

SUBJECTS

Representative adult T2DM patients and age-matched and sex-matched nondiabetes individuals were selected from the 2000, 2005, and 2010 National Health Insurance Research Databases.

MEASURES

Healthcare use included physician visits, hospital admissions, and antidiabetic drug prescriptions. Indicators of diabetes management included completeness of recommended diabetes tests and medication adherence, assessed using medication possession ratio.

RESULTS

The total healthcare cost per diabetes patient was approximately 2.8-fold higher than that for nondiabetes individual. The growth of healthcare cost per diabetes patient was significantly contained by about 3694 New Taiwan dollars (3.6%) between 2005 and 2010, but diabetes care improved over the decade. Diabetes duration, income, place of residence, continuity of care, and enrollment to a pay-for-performance program were associated with healthcare costs and diabetes management. Some public health measures implemented to support diabetes care were also discussed.

CONCLUSIONS

Healthcare costs could be controlled without sacrificing the quality of diabetes care by implementing pay-for-performance programs and effective health policies favorable for diabetes care.

摘要

背景

对于一项采用成本控制策略的全民健康保险计划如何影响糖尿病护理的成本和质量，人们了解甚少。

目的

研究过去十年台湾2型糖尿病（T2DM）患者的医疗服务使用情况和费用趋势，并确定与高医疗费用和糖尿病护理不佳相关的因素。

研究设计

我们描绘了2000 - 2010年T2DM患者的医疗服务使用模式和费用情况。使用广义线性和逻辑回归模型来确定与医疗费用和糖尿病护理相关的因素。

研究对象

从2000年、2005年和2010年的国民健康保险研究数据库中选取具有代表性的成年T2DM患者以及年龄和性别匹配的非糖尿病个体。

测量指标

医疗服务使用情况包括就诊次数、住院次数和抗糖尿病药物处方。糖尿病管理指标包括推荐的糖尿病检查的完整性和药物依从性，通过药物持有率进行评估。

结果

每位糖尿病患者的总医疗费用比非糖尿病个体高出约2.8倍。2005年至2010年期间，每位糖尿病患者的医疗费用增长显著得到控制，减少了约3694新台币（3.6%），但在这十年间糖尿病护理有所改善。糖尿病病程、收入、居住地点、护理连续性以及参与绩效付费计划与医疗费用和糖尿病管理相关。还讨论了为支持糖尿病护理而实施的一些公共卫生措施。