Zhongguo quanke yixue (Jul 2022)
The Concentration of Healthcare Expenditures in Type 2 Diabetes Patients with Essential Medical Insurance Coverage
Abstract
Background Both excessive utilization and underutilization of medical services affect the fairness in the use of medical services. Therefore, studying the concentration of healthcare expenditures on chronic diseases, and analyzing the characteristics of patients with high and low medical expenditures could assess the fairness of the essential medical insurance system. Objective To analyze the concentration of healthcare expenditures in type 2 diabetes mellitus (T2DM) patients with essential medical insurance coverage. Methods Data of patients with a first diagnosis of T2DM and coverage of essential medical insurance were collected from the information system of a municipal medical insurance center in Jiangsu Province in July 2019, involving 24 107 cases with urban resident basic medical insurance (URBMI) and 109 265 cases with urban employee basic medical insurance (UEBMI) . Patients in each group were subgroup by the level of personal healthcare expenditure from high to low (percentile subgroups 1-5: top 1%, top 1%-5%, top 5%-10%, top 10%-50% and the remaining 50%) , and inter-percentile subgroup comparisons of the healthcare expenditure, medical insurance reimbursements, health service utilization, and population features were performed. Results Both healthcare expenditures and medical insurance reimbursements were highly concentrated in each group of T2DM patients: the healthcare expenditure of patients with URBMI in subgroups 1 and 2 accounted for 66.12% of the total healthcare expenditures, and medical insurance reimbursements of those with URBMI in subgroups 1, 2 and 3 accounted for 82.97% of the total medical insurance reimbursements. The healthcare expenditure of patients with UEBMI in subgroups 1 and 2 occupied 43.12% of the total healthcare expenditure, and medical insurance reimbursements of those with UEBMI in subgroups 1, 2 and 3 occupied 61.62% of the total medical insurance reimbursements. Gender, age and the perferred medical institutions were significantly different between patients in subgroups 1 and 2 and those in other three subgroups, and between patients in subgroups 1, 2, 3, and 4, and those in subgroup 5 regardless of the type of medical insurance (URBMI or UEBMI) (P<0.05) . Conclusion The healthcare expenditures and medical insurance reimbursements in insured T2DM patients were highly concentrated. In particular, the level of concentration of medical insurance reimbursements in those with URBMI was higher than that of those with UEBMI. The high concentration of healthcare expenditures indicates that T2DM patients with high healthcare expenditures may have excessive medical utilization and moral risk. Policy effort should be paid to the reimbursements level of those with low-to-moderate healthcare expenditures, and to improve their access to healthcare services.
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