Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China

Abstract

BackgroundThe incidence of type 2 diabetes is increasing, creating a huge burden for China’s social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China.MethodsA total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients’ admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed.Results(1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care.ConclusionsMedical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2140-4) contains supplementary material, which is available to authorized users.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

“…The total annual direct cost per patient increased with the number of complications (Figure 1), primarily driven by inpatient and medication costs. The mean direct costs per patient associated with incident, acute macrovascular, microvascular, and metabolic complications ranged from €11,548 (acute coronary syndrome, France) [172] to €26,090 (incident cardiovascular disease [CVD], UK [173]) in EST markets and from €1,504 (ischemic heart disease, China [174]) to €8,786 (acute myocardial infarction, China [175]) in EMG markets. The mean direct costs per episode per patient associated with the management of chronic comorbidities ranged from €1,323 (retinopathy, Italy [176]) to €9,497 (established CVD, UK [173]) in EST markets and from €769 (microvascular disease, China [177]) to €4,865 (chronic kidney disease (CKD), China [178]) in EMG markets (Figure 2).…”

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil

“…Studies have demonstrated that people with diabetes are at higher risk of hospitalization [ 8 , 9 , 10 , 11 ] and readmission than people without diabetes [ 12 , 13 ]. The diabetes economic burden is significant and is expected to increase over time.…”

Pre- and intra-operative predictors of postoperative hospital length of stay in patients undergoing radical prostatectomy for prostate cancer in China: a retrospective observational study

“…Another noteworthy point is that Chinese doctors tend to be more conservative and cautious in ensuring that patients achieve a stable state before discharging them from hospital, their motivation being to avoid potential challenges, legal action, or even threats from patients or their families, as have occurred in association with tense doctor–patient relationships in China, especially in recent years [ 21 , 22 ]. All the above reasons likely contribute to the much longer LOS for both patients with prostate cancer and those with other diseases [ 15 , 17 , 23 ] in China than in Western studies.…”