Health care utilization and costs in Saskatchewan's registered Indian population with diabetes.
BACKGROUND
The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan.


METHODS
Administrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis) and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined.


RESULTS
Registered Indian diabetes cases were younger than general population cases (45.7 +/- 14.5 versus 58.4 +/- 16.4 years, p < 0.001) and fewer were male (42.3% versus 53.2%, p < 0.001). Registered Indians were more likely to visit a physician, be hospitalized or receive dialysis than the general population, regardless of diabetes status. Diabetes increased the probability of having used all resource categories for both Registered Indians and the general population. Per capita health care expenditures for the diabetes subgroups were more than twice that of their respective controls and were 40% to 60% higher for registered Indians than the general population, regardless of diabetes status.


CONCLUSIONS
Relative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.
Pohar
Sheri L
SL
Canadian Agency for Drugs and Technology in Health, Ottawa, Canada. sherip@cadth.ca
Johnson
Jeffrey A
JA
D000328:Adult; D003920:Diabetes Mellitus / Q000191:economics / Q000208:ethnology* / Q000628:therapy; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D011159:Population Surveillance; D015995:Prevalence; D012042:Registries; D012111:Residence Characteristics; D012525:Saskatchewan / Q000453:epidemiology
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