https://scholars.lib.ntu.edu.tw/handle/123456789/190314
標題: | Accountability, utilization and providers for diabetes management in Taiwan, 2000-2009: An analysis of the National Health Insurance database | 作者: | TIEN-JYUN CHANG YI-DER JIANG CHIA-HSUIN CHANG Chung, Ching-Hu Yu, Neng-Chun LEE-MING CHUANG |
關鍵字: | accountability;diabetes;health provider;utilization | 公開日期: | 2012 | 卷: | 111 | 期: | 11 | 起(迄)頁: | 605-616 | 來源出版物: | Journal of the Formosan Medical Association | 摘要: | Background/Purpose: The prevalence of diabetes has increased worldwide. To obtain nation-wide 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. Methods: 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. Results: 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. Conclusion: 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. Copyright (c) 2012, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/259196 http://ntur.lib.ntu.edu.tw/bitstream/246246/259196/1/index.html |
DOI: | 10.1016/j.jfma.2012.09.011 | SDG/關鍵字: | ambulatory care; article; cardiovascular disease; cerebrovascular accident; clinical examination; controlled study; data base; diabetes mellitus; diabetic nephropathy; diabetic patient; diabetic retinopathy; emergency care; health care cost; health care personnel; health care system; health care utilization; hemodialysis; hospital discharge; hospital patient; hospitalization; human; ICD-9-CM; major clinical study; medical examination; multicenter study; national health insurance; outcome assessment; outpatient department; peripheral vascular disease; Taiwan; trend study; Adult; Aged; Databases, Factual; Diabetes Mellitus; Female; Health Resources; Hospitalization; Humans; Male; Morbidity; National Health Programs; Retrospective Studies; Social Responsibility; Taiwan |
顯示於: | 醫學系 |
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