HEALTHCARE FINANCIAL MANAGEMENT

Healthcare Financial Management and Type-2 Diabetes

Healthcare Financial Management and Type-2 Diabetes

Type 2 Diabetes

About 95 percent of diabetics have type 2 diabetes, formerly known as diabetes mellitus or diabetes onset in adulthood. Many people with type 2 diabetes do not respond normally to its own insulin or that are injected. This is known as insulin resistance. Type 2 diabetes occurs most often in people over 40 years. Many who suffer are obese. Many are unaware they have diabetes. Some people with type 2 diabetes control their blood sugar levels planning meals and exercise. Other tablets should be taken that stimulate insulin production, reduce the resistance thereof, decrease liver glucose output or slow the absorption of carbohydrates within the gastrointestinal tract. Other people also require insulin injections.

The cost of hospitalization

Approximately 13,800 hospitalizations each year are attributable to diabetes, 2700 being coded main causes and related causes in 11 100. Between 1999 and 2004, the proportion of insulin-treated patients increased from 22% to 32%. Note that the prevalence of health-seeking increases mainly from 55 years, with rates up to 120 to 1000 between 75 and 84 years.

In 2004, three out of five patients were women, mean age 62 years. Half of hospitalizations has one or more complications, whether ocular, vascular, or other multiple. According to the complication, length of stay varies from 4.5 days, if the stay is linked to diabetes during pregnancy, 13 days for diabetics with vascular problems.

A survey was conducted in the diabetology department of Reunion South Hospital Group in Saint-Pierre on all patients hospitalized between April 28 and August 4, 2006, a sample of 195 patients, whose characteristic was to be identified as type 2 diabetes for at least a year, and who were interviewed about their use of care during 2005.

It is important to note that this survey covered a population composed mainly of insulin-treated and hospitalized primarily because of poor balance of their diabetes. Drug costs and nursing care is overestimated. At age 60, 93% of patients taking drugs to treat diseases related to diabetes complications. The survey identified two opposite types of behavior. Thus 24% of respondents (n = 47) saw no specialist in 2005, it is therefore in the presence of non-compliance with recommendations (at least one visit per year to a cardiologist and an ophthalmologist). Conversely, there is an overconsumption primarily ambulatory care patients with low insulin-treated self.

Besides the cost laboratory procedure that could not be estimated from the survey and visits with a dietitian or podiatrist who have not been collected, the average annual cost per diabetic is approximately 5450 €. In total, more than a third of this budget is related to drugs, just under one third to fifth nursing and hospitalization. Note that almost a third of the budget is devoted to the management of diabetes complications. This is significantly higher than the average expenditure of the general scheme in Reunion, under health insurance, which were € 1 815 per capita in 2004.

It is also interesting to recall the results of a study conducted by health insurance in France (4), whose objective was to analyze databases of CPAM for reimbursement...