Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

Abstract

Objective: Thailand has three healthcare insurance schemes, including: Universal Health Coverage (UHC), Social Health Insurance (SHI), and Civil Servant Medical Benefit (CSMB). UHC has the narrowest drug coverage, SHI uses its own list, and CSMB offers the greatest drug coverage. The aim of this study was to investigate metabolic goal achievement in patients with type 2 diabetes mellitus (T2DM) compared among the three healthcare schemes in Thailand. Methods: Data were obtained from a nationwide survey administered by MedResNet during 2011 to 2012. A cross-sectional survey was conducted in patients with T2DM aged >35 years who were treated for at least 12 months. The data were retrospectively collected from medical records. Results: Of 49,303 T2DM patients that were recruited, 69.8% were female. CSMB patients were the oldest and had the longest diabetes duration. Achievement of BP, HbA1c, and LDL goals was 32.8%, 33.3%, and 42.5%, respectively. UHC patients had the highest percentage of BP control achievement (<130/80 mmHg; 33.1%), while CSMB patients had the highest percentage of HbA1c (<7%; 40.4%) and LDL (<100 mg/dL; 49%) achievement. CSMB patients had the highest prevalence of 2-goal (16.8% for T2DM without HT) and 3-goal achievement (8.2% for T2DM with HT). Multivariate analysis revealed the CSMB scheme to be significantly associated with 3-goal achievement compared to the UHC scheme (odds ratio: 1.48, 95% confidence interval: 1.30-1.67; p<0.01). Conclusion: The prevalence of metabolic goal achievement in patients with T2DM in Thailand is low. CSMB patients have the highest prevalence of 2-goal and 3-goal achievement.

Keywords

• Blood pressure; glycemic level; health insurance; lipid level; type 2 diabetes mellitus