| Summary: | 碩士 === 中國醫藥學院 === 醫務管理研究所 === 89 === If a chronic disease is not properly subdued by effective control, it is quite possible to lead to many devastating complications. Other than wasting more medical resources, the uncertainty can also greatly affects the quality of the patient’s life. Taiwan''s current regional prevalence rate of diabetes is about 4%, its annual incidence rate is around 1.8%, and the disease ranks the fifth most fatal on our ten top disease list. Department of Health is expecting to keep expanding an existing disease management program based on shared-care model for diabetic (DM) patients. Hopefully, through the establishment of a standardized treatment guideline, it would further improve the care quality and therapeutic effectiveness of DM patients, also to contain the cost of DM care within a reasonable range.
This study of ours made use of the DM database of Bureau of National Health Insurance (BNHI), specifically all detail files of the outpatient, emergency, impatient prescriptions and treatment records during the period from 1996 to 1999. That is, all those files having at least one diagnostic code belonging to diabetes or related disorders (the first three digits of ICD-9-CM are 250, and the A-code digits are 181) were used in this study. The objective of this study was to analyze the nationwide medical costs and medical service utilization by DM patients in order to understand how DM patients took advantages of the medical services in those years. Also the study was specifically aiming at I-lan County, which launched the shared-care model DM management program in 1997, we wanted to find out the differences in medical service utilization before and after the program kicked off.
Our major findings are as follows:
1. The total number of DM patients in the entire country who visited a doctor because of DM during the period from1996 to 1999 was 1626397. The utilization rates of various medical services were: inpatients 23.68%, outpatients 95.14%, and emergency 9.82%
2. The annual utilization details of various medical services by an average DM patient of the country are: number of hospitalization 1.557 times, total medical expenses for the hospitalized NT$72449.35, hospitalized medicine cost was 17.74% of the above total, and average length of hospitalization 17.16 days; number of outpatient visiting a doctor 7.549 times, total medical expenses for outpatient calls NT$9179.69, outpatient medicine cost was 66.79% of the above total, and the average number of medicine offering days for outpatient calls 18.25; number of emergency calls 1.306 times, total medical expenses for emergency calls NT$3922.09, emergency medicine cost was 11.04% of the
above total, and the average number of medicine offering days for emergency calls 2.75.
3. As to the national distribution of medical service utilization by DM patients, we have found that female patients were using the medical services more frequently than men, whereas the medical costs incurred per annual per person were higher by male patients.
4. Overall speaking, nationwide DM patients'' medical care utilization frequency and medical cost were both on the rise in all those years, while the situation of incidental complications and severity of the disease were both lack of evident improvement. Also there was a trend that more and more DM patients chose to visit larger sized medical centers for medical help, and the utilization rate of services offered by basic clinics by DM patients was apparently dropping.
5. In the case of I-lan County, the average medical service utilization situation over there was essentially about the same as the average of the entire country before their implement of the shared-care model DM management program. But after 1997 when the program started, although there has been no obvious decrease in medical expenses by DM patients there, amplitude of the increase turned out to be less than the national average, plus the disease situation appeared more stable. Furthermore, in the aspects of total utilization frequency, steadiness of seeking medical help, and complication situation, there seemed to have an improving tendency year after year.
Based on the above analyses, we have the following recommendations:
1. To promote nationwide shared-care model DM management program. Based on the social and economical characteristics and medical resources of each individual county, to establish its own treatment guidelines and disease administration model.
2. To encourage medical institutions, hospitals and clinics, to establish an at-home managing program for each individual DM case.
3. To design and develop a simple and easy DM decision support system.
4. Through the shared-care program, emphasizing on medical service quality, sharing resources, and healthy consequences, to march on towards the ideal complete "healthy community."
5. To suggest follow-up studies on the expansion of evaluation items for disease administration models.
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