title: Accountability, utilization and providers for diabetes management in Taiwan, 2000-2009: an analysis of the National Health Insurance database.
abstract: OBJECTIVE
  The prevalence of diabetes has increased worldwide. To obtain nationwide data on accountability and utilization of health resources among diabetes patients in Taiwan, an analysis of the claims data for the National Health Insurance (NHI) from 2000 to 2009 was conducted.
  
  
  METHODS
  One-third of the NHI claims database was randomly sampled from 2000 to 2009. Diabetes was defined by three or more outpatient visits with diagnostic codes [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 250 or A code: A181] within 1 year, or one inpatient discharge diagnosis. Accountability items and NHI codes of various metabolic parameters and examinations were identified. Medical utilization was measured by the frequency and cost of care associated with ambulatory visits, hospitalizations, and emergency care within each year.
  
  
  RESULTS
  The annual check-up frequency for various examinations significantly increased from 2000 to 2009. Both the average outpatient department (OPD) cost per diabetes patient/year and the average inpatient department (IPD) cost per time increased 1.34-fold in the past decade. The average OPD cost per diabetes patient and average IPD cost of each admission for diabetes patients was four times and 1.4 times compare with the general population, respectively. The annual average medical cost of each diabetes patient affected with both micro- and macrovascular complications was four times compared with those without vascular complications. There was an increasing trend for diabetes patients to visit regional hospital for OPD and IPD, whereas visits to the local hospital decreased in the past decade.
  
  
  CONCLUSIONS
  Due to the increased frequency of annual check-ups after various examinations, the quality of diabetes management has improved in the past decade in Taiwan. As diabetes patients affected with both micro- and macrovascular complications incurred costs four times compared with those without complications, it is worth screening high-risk individuals to ensure earlier intervention and thus reduce diabetic complications and healthcare expenditure.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tien-Jyun
authors.initials: TJ
authors.lastname: Chang
authors.forename: Yi-Der
authors.initials: YD
authors.lastname: Jiang
authors.forename: Chia-Hsiun
authors.initials: CH
authors.lastname: Chang
authors.forename: Ching-Hu
authors.initials: CH
authors.lastname: Chung
authors.forename: Neng-Chun
authors.initials: NC
authors.lastname: Yu
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009313:National Health Programs / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012941:Social Responsibility; D013624:Taiwan / Q000453:epidemiology