title: Trend and factors associated with healthcare use and costs in type 2 diabetes mellitus: a decade experience of a universal health insurance program.
abstract: BACKGROUND
  Little is known about how a universal National Health Insurance program with cost-containment strategies affect costs and quality of diabetes care.
  
  
  OBJECTIVE
  To examine the trends of healthcare use and costs for patients with type 2 diabetes mellitus (T2DM) in Taiwan over the last decade, and to identify factors associated with high healthcare cost and poor diabetes care.
  
  
  METHODS
  We delineated the pattern of healthcare use and costs for T2DM in 2000-2010. Generalized linear and logistic regression models were used to identify factors associated with medical costs and diabetes care.
  
  
  METHODS
  Representative adult T2DM patients and age-matched and sex-matched nondiabetes individuals were selected from the 2000, 2005, and 2010 National Health Insurance Research Databases.
  
  
  METHODS
  Healthcare use included physician visits, hospital admissions, and antidiabetic drug prescriptions. Indicators of diabetes management included completeness of recommended diabetes tests and medication adherence, assessed using medication possession ratio.
  
  
  RESULTS
  The total healthcare cost per diabetes patient was approximately 2.8-fold higher than that for nondiabetes individual. The growth of healthcare cost per diabetes patient was significantly contained by about 3694 New Taiwan dollars (3.6%) between 2005 and 2010, but diabetes care improved over the decade. Diabetes duration, income, place of residence, continuity of care, and enrollment to a pay-for-performance program were associated with healthcare costs and diabetes management. Some public health measures implemented to support diabetes care were also discussed.
  
  
  CONCLUSIONS
  Healthcare costs could be controlled without sacrificing the quality of diabetes care by implementing pay-for-performance programs and effective health policies favorable for diabetes care.
authors.affiliation: *Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan †Department of Health Services Administration, China Medical University, Taichung ‡Taipei City Hospital Fuyou Branch, Taipei §Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County ∥Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei ¶Department of Public Health, Kaohsiung Medical University, Kaohsiung #Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan **Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.
authors.forename: Jur-Shan
authors.initials: JS
authors.lastname: Cheng
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
authors.forename: Chen-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.forename: Hui-Chu
authors.initials: HC
authors.lastname: Lang
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Hsieh
authors.forename: Shyi-Jang
authors.initials: SJ
authors.lastname: Shin
authors.forename: Ted
authors.initials: T
authors.lastname: Chen
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Huang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D011787:Quality of Health Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*; D013624:Taiwan; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents