Outpatient Diabetes Management and the Chronic Care Model

Rodriguez-Saldana, Joel

doi:10.1007/978-3-030-11815-0_20

Cited by 2 publications

(2 citation statements)

References 189 publications

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“…Limited by the inadequate pooled funds at the early times, the Chinese social health insurance system (SHI) gave priority to reimbursing the insured people with major or serious illness [9,10] which could bring a heavy economic burden and disease burden to patients and society like cancer, cirrhosis, heart failure and renal failure [11][12][13], especially in their hospitalization expenses while ignoring the financial support for outpatient services [14,15]. However, comparing with the inpatient services, the outpatient care has a higher utilization frequency and could meet the most of the healthcare needs in many instances [16], such as primary health care services, daily follow-up of chronic diseases and health education to patients [17,18]. The low reimbursement for outpatient expenses brings about a series of problems such as restraint in the demands for healthcare and occurrence of irrational hospitalizations in China [19,20].…”

Section: Introductionmentioning

confidence: 99%

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Liu

2022

Int J Equity Health

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Background: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. Methods: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients’ medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients’ health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. Results: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient’s annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient’s annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient’s annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn’t change. Conclusion: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.

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Section: Introductionmentioning

confidence: 99%

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Liu

2022

Int J Equity Health

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show abstract

“…To our knowledge there are no prospective randomized controlled trials which examined specifically the effects of specialized multidisciplinary outpatient diabetes programs on the hospital readmission rates in patients with diabetes. Multiple studies have shown that such programs improve glycemic control (18,19), therefore reducing the risk of microvascular and long-term macrovascular complications of diabetes (20)(21)(22)(23)(24)(25)(26). These programs, however, have not been widely implemented by health care systems because their relatively high cost and poor reimbursement often produce a budget deficit (27).…”

Section: Discussionmentioning

confidence: 99%