Institute for Research and Information in Health Economics (IRDES), Paris, France.
Department of Economics (LEDa), University Dauphine PSL, Paris, France.
Health Serv Res. 2021 Dec;56 Suppl 3(Suppl 3):1358-1369. doi: 10.1111/1475-6773.13854. Epub 2021 Aug 19.
To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.
Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.
Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.
We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures.
In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97).
Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
比较 9 个国家（澳大利亚、加拿大、英格兰、法国、德国、新西兰、西班牙、瑞士和美国）中患有慢性心力衰竭（CHF）和糖尿病患者的国内卫生保健利用和支出的差异。
患者水平的相关数据来自于 9 个国家的国际协作，数据来源于 2015/2016 年的常规医院数据，患者的主要诊断为 CHF，次要诊断为糖尿病。
我们计算了每位患者在一年的住院后整个医疗护理路径中的护理消费，包括从初级保健到家庭保健护理。为了比较每个国家的护理消费分布，我们使用基尼系数、洛伦兹曲线和 8 种利用和支出措施的女性-男性比例。
在所有国家，康复和家庭护理都高度集中在患者的前十分位，而药物处方的数量分布更为均匀。平均而言，药物消费的基尼系数约为 0.30（95%置信区间（CI）：0.27-0.36），而初级保健就诊的基尼系数为 0.50（0.45-0.56），康复和家庭护理的基尼系数超过 0.75（0.81-0.92）（0.78；0.62-0.9）。支出的变化比利用更为明显。与男性相比，女性在初次住院时的住院天数增加了（+5%，1.01-1.06），药物处方增加了（+7%，1.05-1.09），康复和家庭护理的使用显著增加（20%至 35%，0.79-1.6，0.99-1.64），但专科就诊减少（-10%，0.84-0.97）。
不同国家内卫生保健消费的分布存在差异，但所有国家也存在一些共同的治疗模式。临床医生和政策制定者需要研究这些按性别和护理环境划分的护理利用差异，以确定这些差异是否合理，或者是否表明护理不足。
