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Is There A Non-Essential Hospitalization Day In Inpatients With Diabetes Under Medical Insurance? Evidence From An Observational Study In China

Authors Tao S, Li H, Xie Y, Chen J, Feng Z

Received 20 June 2019

Accepted for publication 24 September 2019

Published 6 November 2019 Volume 2019:12 Pages 2309—2316

DOI https://doi.org/10.2147/DMSO.S220238

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Juei-Tang Cheng


Siyu Tao,1 Haomiao Li,1 Yueyin Xie,2 Jiangyun Chen,3 Zhanchun Feng1

1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2School of Automobile, Tongji University, Shanghai, People’s Republic of China; 3School of Health Service Management, Southern Medical University, Guangzhou, People’s Republic of China

Correspondence: Zhanchun Feng
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Qiaokou District, Wuhan, Hubei 430030, People’s Republic of China
Tel +86 27 83692731
Email zcfeng@hust.edu.cn

Jiangyun Chen
School of Health Service Management, Southern Medical University, No. 1023-1063 Shatainan Road, Baiyun District, Guangzhou, Guangdong 510515, People’s Republic of China
Tel +86 185 8822 0304
Email jy2006126@126.com

Purpose: Non-essential hospitalization day of inpatient diabetes threatens health seriously and contributes to great economic burden on individuals and the society. Studying the essential utilization of hospitalization services is conducive to the reduction in the burden of diabetes. The purpose of this study is to identify the existence of non-essential hospitalization days during hospitalization in diabetic patients through exploring the use of health care in different types of insured patients.
Patients and methods: A sample of 6731 admission records from 5929 hospitalized patients was studied. Binary logistic regression was performed to estimate the adjusted effects of health insurance status on readmission. Multiple stepwise linear regression was performed to estimate the adjusted effects of health insurance status on length of stay (LOS), direct medical expenses (DME), out-of-pocket (OOP) expenditures, and percentage of individual payment after reimbursement (PIPAR). Adjusted odds ratios (with 95% CI) were reported as the results of logistic regression models and linear regression models, respectively.
Results: Adjusted 7-day readmission rate and 30-day readmission rate were not significantly different between urban and rural resident basic medical insurance (URRBMI) and urban employee basic medical insurance (UEBMI). Compared with inpatients under URRBMI, the adjusted LOS and DME were significantly higher for UEBMI inpatients (adjusted OR of 2.6, 95% CI=1.9–3.2, adjusted OR of 1870.85, 95% CI=1370.97–2370.73, respectively). Adjusted OOP and PIPAR were significantly lower for UEBMI inpatients (adjusted OR of-970.86, 95% CI =−1111.63–−830.10, adjusted OR of −0.19, 95% CI=−0.20–−0.18, respectively).
Conclusion: There was a non-essential hospitalization day existing in the treatment of diabetes. Moral hazard has been found in UEBMI which would trigger overtreatment in hospitalization of diabetics, and the lower PIPAR of UEBMI was one of the main causes of moral hazard.

Keywords: diabetes, readmission rate, hospitalization day, medical insurance, moral hazard, overtreatment
 

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