Diabetes Mellitus Management Status And Its Influencing Factors With Analysis Of Treatment Cost In Chongqing

Objective: This study investigate the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes,in terms of the essential public health service package in China and the regional practice guideline;and analyzed factors associated with the use of care.Meanwhile,to compare the treatment costs on type 2 diabetes between patients with and without specific diseases health insurance,and to identify the influencing factors related to specific diseases health insurance application.Methods: A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing.Total 502 patients completed the interview.A structured questionnaire was used to investigate basic information,follow up and health service utilization,diabetes-related pharmacy,outpatient and inpatient treatment costs.SAS9.1 software was used for statistical analysis.Continuous variables were represented by median(inter-quartile range)M(Q),and were analyzed using Wilcoxon test.The enumeration data was analyzed using Chi-square test,and variables of statistical difference were bought into multivariate unconditional Logistic regression model through stepwise method.Results: In terms of health management,64.99% of participants had four or more follow-up visits.In light of the recommended tests,the proportions of having Hb A1 c test,blood lipid test and screening for nephropathy and eyes annually were 8.06,54.23,44.56 and 43.55%,respectively.The results of logistic regression show that the patients who were covered by Urban Employee Basic Medical Insurance,were enrolled in the targeted disease reimbursement program,and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests.On the treatment costs,compared with patients without specific disease health insurance in outpatient group,patients with specific disease health insurance had higher annual per capita total cost [2160(3081)vs.1000(2100)yuan,P <0.01] and lower out-of-pocket expense ratio(54.04% vs.93.78%).Patients with middle or high level income(OR=1.94 and 2.11),participated in urban employee basic medical insurance(OR = 4.19)and duration of disease >5 years(OR = 2.04)were more likely to succeed in specific diseases health insurance application.Conclusions: Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period,as indicated in the regional practice guideline.It perhaps related to the type of medical insurance and the duration of the disease.It is recommended in the early stages of the disease,to strengthen health education and lifestyle behavior intervention.Meanwhile,to reduce the financial burden of patients with type 2 diabetes,government should make huge efforts to promote specific disease health insurance policies,and encourage patients to apply for it.Then medical insurance department and medical institutions should reinforce supervision and simplify the application process.To improve the availability of specific disease health insurance,the number and coverage of designated retail pharmacies should be increased.Last but not least,government should pay more attention to low-income patients and those with short duration diabetes,so as to enhance their ability to resist economic risks and reflect the fairness of specific disease health insurance.