710 901
1,2 3 3 3 3
1
2
3
1998 2000
1998 2000 3
64
13.5 3 12.2%
1.63 10.3
2000 13%
( Diabetes mellitus ) ( Medical care )
( Medical expenditures ) ( National health insurance )
( National health insurance research database )
WHO
2025
1985 1996
3 0 - 4 0 3 . 4 %
9 . 2 %
4 % 6 5 -
74 10%
1,21987 2002
3,4
1998
5 4 6.2% 1998
11.5%
350 60.8%
3 9 . 2 %
22.2
4.3
1,25-8
1998 2000
1998 2000
( ICD-9-CM 250 648.8 648.0 775.1 790.2 )
( 250 98%
ICD 250 )
SAS8.2
1998 144,379 ( 228,326 ) 1999 155,183
( 247,940 ) 2000 161,952
( 263,638 ) 1998 2000 17,573
( 35,312 )
( ) 3
12.2%
1.63
6 4 1 3 . 5
1:1.03 74
65~74 ( )
94.5% 30
10.3 5.5%
3 0 2 5 2
2 0 0 0
3 9 . 6 7.23
1 9 9 8 10,759,800,000 1999 12,458,700,000
2000 13,428,300,000
50,000 ( ) 2000
1 , 8 2 8 , 6 0 2 ( 2 , 6 9 0 , 8 4 7 )
101,222,637,721
1998 1999 2000
228,326 115,874 112,329 247,940 125,308 122,499 263,638 132,087 131,397 144,379 73,550 70,729 155,183 78,787 76,287 161,952 81,437 80,387
1998 1999 2000
( ) 10,759,800,000 12,458,700,000 13,428,300,000
47,125.04 50,248.83 50,934.59
83,923.57 87,962.51 86,116.63
21,499 22,528 22,971
36,171 2000
13%
( )
I C D
31%
( )
I C D
3 2 %
( )
5%
1998 6,586 ( 10,942 ) 1999
7,606 ( 12,932 ) 2000 8,458
( 1 4 , 6 3 6 ) 3 1 , 8 7 2
( 3,694 ) 28.4%
6 4
65-74 34.4% 55-64
( 15 )
1998 (%) 1999 (%) 2000 (%)
* 11.65 12.07 12.59
434 5.52 5.35 5.33
414 3.86 3.80 3.83
250 3.33 3.21 3.15
571 2.45 2.35 2.36
428 2.03 2.14 2.20
585 1.81 1.72 1.75
402 1.76 1.61 1.49
493 1.72 1.63 1.44
531 1.68 1.77 1.83
496 1.49 1.43 1.45
820 1.30 1.32 1.25
574 1.29 1.19 ----
155 1.27 ---- 1.44
532 1.25 1.24 ----
* (ICD) (599) (486) (682) (590) (038)
ICD
ICD 1998 1999 2000
(%) (%) (%)
250.0 2,416 5.60 1,772 4.07 1,817 4.03
250.1 2,490 5.77 2,624 6.02 2,569 5.68
250.2 2,183 5.06 2,424 5.56 2,714 6.02
250.3 545 1.26 650 1.49 671 1.49
250.4 6,937 16.07 7,561 17.35 7,243 16.06
250.5 2,803 6.49 2,784 6.39 2,675 5.93
250.6 3,105 7.19 2,927 6.72 2,818 6.25
250.7 3,889 9.01 3,899 8.95 4,821 10.69
250.8 ( ) 4,185 9.69 4,575 10.50 5,052 11.20
250.9 13,867 32.12 13,523 31.02 13,741 30.47
42,420 98.26 42,739 98.05 44,114 97.82
1 1998 720 1999 130 2000 22
2 ICD 250 98% ICD 648.8 648.0 775.1 790.2 2%
ICD 1998 % 1999 % 2000 %
250.0 4.08 3.33 4.10
250.1 11.34 11.79 9.23
250.2 18.14 19.49 19.74
250.3 3.17 2.31 3.33
250.4 23.36 21.28 20.26
250.5 1.13 1.03 0.26
250.6 0.23 0.77 1.28
250.7 14.74 18.97 18.46
250.8 8.39 6.41 11.03
250.9 15.42 14.62 12.31
1998 1999 2000
1 (250)
2 (038) (486)
3 (518)
4
5 (785)
6 (434) (410)
7
8 (428)
9 (431) (162)
10 (155)
27.5% 75 18.2% 55
45-54
1998 14.4% 2000
15.5%
2 0 0 0
16.45 123,332
1998 1,376,367,623 1999 1 , 6 2 9 , 5 4 9 , 5 3 8 2 0 0 0
1,805,087,168 2
2000
16.75% 4,000
6.12%
( arteriovenostomy )
7 0 . 3 1 2
2 8 . 8 1 5 . 3
( )
( )
17.8%
8.5%
8
1996-2000
20%
9( ketoacidosis ) ( hyperglycemic hyperosmolar
syndrome ) ( hypo-
glycemia )
8,10
4,000
1 9 9 9 2 8 , 0 0 0
150
11
2
12
0.1%
I C D 1998
1.7%
9 7 %
13,14
(CMFHR9120)
1. ( 92 12
)
2.Lin T, Chou P, Lai MS, Tsai ST, Tai TY. Direct costs-of-illness of patients with diabetes mellitus in Taiwan. Diab Res Clin Pract 2001; 54: S43-6.
3.Chan JCN, Ng MCY, Critchley JAJH, Lee SC, Cockram CS.
perspective. Diab Res Clin Pract 2001; 54: S19-54.
4.Pan WH, Yeh WT, Hwu CM, Ho LT. Prevalence of diabetes mel- litus in Taiwan. In: Pan WH, ed. Report of nutrition and health survey in Taiwan, 1993-1996. Department of Health 1998: 279- 90.
5.Ratner RE. Long-term health care outcomes in diabetes.
Economic and political implications. Endo Meta Clin North Am 1997; 26: 487-98.
6.McGuire A. Economic analysis of diabetes. J Diab its Complicat 1996; 10: 149-50.
7.Hodgson TA, Cohen AJ. Medical care expenditures for diabetes, its chronic complications,and its comorbidities. Preven Med 1999; 29: 173-86.
8.Currie CJ, Morgan CL, Peters JR.The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neu- ropathy, and ulceration in diabetes. Diabetes Care 1998; 21: 42- 8.
9. 1996-2000
2002; 21: 173-80.
10.
2002; 21: 115-22.
11.Yang WC, Hwang SJ, Chiang SS, Chen HF, Tsai ST. The impact of diabetes on economic costs in dialysis patients: experiences in Taiwan. Diab Res Clin Pract 2001; 54: S47-54.
12.Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA 2001; 285: 182-9.
13.American Diabetes Association. Economic consequences of di- abetes mellitus in the US in 1997. Diabetes Care 1998; 21: 296- 309.
14.Bjork S. The cost of diabetes and diabetes care. Diab Res Clin Pract 2001; 54: S13-8.
..
Analysis of Diabetic Inpatient Care by Using NHI Claims
Hon-Mei Cheng
1,2, Ming-Jen Win
3, Hui-Ling Chou
3,Wan-Yu Lee
3, and Chen-Ying Tsai
3This study is designed to evaluate and trend the national-wide inpatient care of diabetics in Taiwan from 1998 to 2000. This study is based in part on data from the National Health Insurance Research Database pro- vided by the Bureau of National Health Insurance, Department of Health to determine the demographic and clin- ical characteristics, various complications, mortalities, and annual health care costs for inpatient diabetes in 1998- 2000. The average age of inpatient diabetics were 64 years old. The number of hospital inpatient diabetics in Taiwan was increased 12.2% during the period from 1998 to 2000 with 1.63 time of admission per year for each inpatient diabetics. The average hospital days per admission were 10.3 days. The annual cost for diabetic inpa- tient care expenditure was increased gradually from 1998 to 2000, the annual cost of diabetic inpatient care ex- penditure accounted for 13% of total inpatient care expenditure in 2000. As compared to non-diabetic patients, the diabetic patients were older and had longer hospital stay and more inpatient costs, especially for those dia- betic patients under dialysis therapy. The most common problems for admission were diabetic-related complica- tions, such as infectious diseases, cerebrovascular diseases and chronic ischemic heart diseases. The mortali- ty rate of inpatient diabetics was almost double than non-diabetic inpatient population. The economic burden of diabetes mellitus in Taiwan is enormous. Further potential savings strategy and quality control for this disease is mandatory. ( J Intern Med Taiwan 2005; 16: 121-128 )
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center
2
Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science
3
