Kumagai Narimasa, Jakovljević Mihajlo
Faculty of Economics, Seinan Gakuin University, Fukuoka, Japan.
UNESCO-TWAS, Section of Social and Economic Sciences, Trieste, Italy.
Front Public Health. 2024 Jul 17;12:1382354. doi: 10.3389/fpubh.2024.1382354. eCollection 2024.
Precise prediction of out-of-pocket (OOP) costs to improve health policy design is important for governments of countries with national health insurance. Controlling the medical expenses for hypertension, one of the leading causes of stroke and ischemic heart disease, is an important issue for the Japanese government. This study aims to explore the importance of OOP costs for outpatients with hypertension.
To obtain a precise prediction of the highest quartile group of OOP costs of hypertensive outpatients, we used nationwide longitudinal data, and estimated a random forest (RF) model focusing on complications with other lifestyle-related diseases and the nonlinearities of the data.
The results of the RF models showed that the prediction accuracy of OOP costs for hypertensive patients without activities of daily living (ADL) difficulties was slightly better than that for all hypertensive patients who continued physician visits during the past two consecutive years. Important variables of the highest quartile of OOP costs were age, diabetes or lipidemia, lack of habitual exercise, and moderate or vigorous regular exercise.
As preventing complications of diabetes or lipidemia is important for reducing OOP costs in outpatients with hypertension, regular exercise of moderate or vigorous intensity is recommended for hypertensive patients that do not have ADL difficulty. For hypertensive patients with ADL difficulty, habitual exercise is not recommended.
准确预测自付费用以改善卫生政策设计，对实行国家医疗保险的国家政府而言至关重要。控制高血压（中风和缺血性心脏病的主要病因之一）的医疗费用，是日本政府面临的一个重要问题。本研究旨在探讨自付费用对高血压门诊患者的重要性。
为了精确预测高血压门诊患者自付费用最高四分位数组的情况，我们使用了全国性纵向数据，并估计了一个随机森林（RF）模型，该模型侧重于与其他生活方式相关疾病的并发症以及数据的非线性特征。
RF模型结果显示，对于日常生活活动（ADL）无困难的高血压患者，自付费用的预测准确性略高于过去连续两年持续就诊的所有高血压患者。自付费用最高四分位数的重要变量包括年龄、糖尿病或血脂异常、缺乏习惯性运动以及中度或剧烈的规律运动。
由于预防糖尿病或血脂异常并发症对于降低高血压门诊患者的自付费用很重要，因此建议没有ADL困难的高血压患者进行中度或剧烈强度的规律运动。对于有ADL困难的高血压患者，不建议进行习惯性运动。
