title: Factors affecting costs and utilization of type 2 diabetes healthcare: a cross-sectional survey among 15 hospitals in urban China.
abstract: BACKGROUND
  Type 2 Diabetes mellitus (T2DM) affects persons of all ages, while also placing heavy economic burdens on national economies and healthcare systems. The study aims to investigate the determinants of direct medical cost (DMC), out-of-pocket (OOP) proportion of the cost, and healthcare utilization associated with T2DM.
  
  
  METHODS
  This cross-sectional study was conducted in four major cities in China. Eligible subjects were adult outpatients who received treatment at one of 15 sampled secondary or tertiary hospitals and consecutively enrolled between March 2007 and May 2007. Generalized estimating equations were used to determine impact factors associated with DMC and healthcare utilization.
  
  
  RESULTS
  Insurance schemes and receiving insulin therapy were significantly associated with a higher annual DMC of T2DM. For each increase in number of complications, there was about 33% increase in annual DMC. Insurance schemes were significantly associated with the proportions of DMC from pocket. A 7% significantly lower proportion of DMC was paid and 23% more clinic visits (AOR = 1.232, P < 0.001) were made by patients admitted at secondary hospitals than tertiary hospitals. The group with higher income (> 2000 CNY/month) paid 23% less from their pocket, compared with the lower income group. The number of complications also significantly increased the outpatient visits (AOR = 1.064, P < 0.001).
  
  
  CONCLUSIONS
  It implies that preventing complications through the use of more effective treatment regimens is important in order to control the healthcare expenditures of the diseases. Healthcare reform needs to be focused on the medical insurance system and redistribution of patients in hospitals of different levels.
authors: School of Public Health, Fudan University, China.
authors: Weibing
authors: W
authors: Wang
authors: Chaowei
authors: C
authors: Fu
authors: Haijing
authors: H
authors: Zhuo
authors: Jianfeng
authors: J
authors: Luo
authors: Biao
authors: B
authors: Xu
mesh_terms: D002681:China; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006786:Hospitals, Urban / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis