Faculty of Medical Informatics, Hokkaido Information University, Hokkaido 069-8585, Japan.
School of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan.
Int J Environ Res Public Health. 2020 Jul 22;17(15):5271. doi: 10.3390/ijerph17155271.
: This study aims to determine the characteristics of Type 2 diabetic patients who are more likely to cause high-cost medical expenses using the Bayesian network model. : The 2011-2015 receipt data of Iwamizawa city, Japan were collected from the National Health Insurance Database. From the record, we identified patients with Type 2 diabetes with the following items: age, gender, area, number of days provided medical services, number of diseases, number of medical examinations, annual healthcare expenditures, and the presence or absence of hospitalization. The Bayesian network model was applied to identify the characteristics of the patients, and four observed values were changed using a model for patients who paid at least 3607 USD a year for medical expenses. The changes in the conditional probability of the annual healthcare expenditures and changes in the percentage of patients with high-cost medical expenses were analyzed. : After changing the observed value, the percentage of patients with high-cost medical expense reimbursement increased when the following four conditions were applied: the patient "has ever been hospitalized", "had been provided medical services at least 18 days a year", "had at least 14 diseases listed on medical insurance receipts", and "has not had specific health checkups in five years". : To prevent an excessive rise in healthcare expenditures in Type 2 diabetic patients, measures against complications and promoting encouragement for them to undergo specific health checkups are considered as effective.
本研究旨在利用贝叶斯网络模型确定导致 2 型糖尿病患者医疗费用过高的特征。
从日本岩见泽市的国民健康保险数据库中收集了 2011-2015 年的收据数据。从记录中,我们确定了患有 2 型糖尿病的患者,包括以下项目:年龄、性别、地区、提供医疗服务的天数、疾病数量、体检次数、年医疗支出以及是否住院。应用贝叶斯网络模型来识别患者的特征,并通过对每年医疗支出至少为 3607 美元的患者进行模型改变,改变了四个观察值。分析了年度医疗支出的条件概率变化和高医疗费用患者比例的变化。
改变观察值后,当满足以下四个条件时,高医疗费用报销患者的比例增加:患者“曾经住院”、“每年至少提供 18 天的医疗服务”、“医疗保险收据上至少列出 14 种疾病”以及“五年内没有进行特定的健康检查”。
为了防止 2 型糖尿病患者医疗支出的过度增长,考虑采取针对并发症的措施并鼓励他们进行特定的健康检查,被认为是有效的。