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背景:糖尿病的成本和经济负担是一个严重的世界性问题。 在这项研究中,我们评估了诊断为糖尿病的人的医疗费用,以及导致糖尿病的人减少其患病率的因素。 方法:使用一个数据集,包含一个健康保险协会的113,979例身体检查和3,671,783个月的医疗,牙科,护理和药房支付记录。 数据集包含正常人和健康人的信息。 样本期间为2013年4月至2016年3月。计算了诊断为糖尿病患者的医疗费用。 回归分析用于消除年龄和性别的影响。 概率分析用于分析导致糖尿病的因素。 结果:在2.9%的病例中,接受检查的人被诊断出患有糖尿病,这些人的医疗费用是每人平均医疗费用的2.7倍。 即使考虑到年龄和性别,该结果也没有明显改变。 概率分析的结果表明,体重指数,收缩压高,舒张压低,饮食习惯,体育锻炼,吸烟,饮酒和睡眠是糖尿病的重要因素。 结论:糖尿病可能是一种比日本以前认为昂贵的疾病。 据估计,这些糖尿病患者的全部医疗费用中有8%的支出,远远高于全国调查数据显示的结果。 但是,可以通过预防超重和肥胖等努力来降低总体患病率。
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Health, 2017, 9, 1113-1127
http://www.scirp.org/journal/health
ISSN Online: 1949-5005
ISSN Print: 1949-4998
DOI:
10.4236/health.2017.98081 Aug. 7, 2017 1113 Health
An Analysis of the Medical Costs of and Factors
Affecting Diabetes Using the Medical Checkup
and Payment Dataset in Japan: Can We Reduce
the Prevalence of Diabetes?
Kazumitsu Nawata
1
, Moriyo Kimura
2
1
Graduate School of Engineering, University of Tokyo, Tokyo, Japan
2
The Public Health Institute, Tokyo, Japan
Abstract
Background
: The cost and economic burden of diabetes are a serious worl
d-
wide issue. In this study, we evaluated medical payments for persons dia
g-
nosed with diabetes and the factors that led to a person having diabetes to r
e-
duce its prevalence.
Methods:
A dataset containing 113,979
medical checkups
and 3,671,783 monthly medical, dental, care-
giving and pharmacy payment
records of one health insurance society was used. The dataset contains info
r-
mation of normal and healthy persons. The sample period ran from April,
2013 to March, 2016. The medical payments for persons diagnosed with d
i-
abetes were calculated. The regression analysis was used to remove the effects
of age and gender. The probit analysis was used to analyze the factors that led
to a person having diabetes.
Results:
In 2.9
% of cases, the person undergoing
the checkup was diagnosed with diabetes, and the medical pa
yments for these
patients were 2.7 times as much as the average medical payment per person.
This result did not change significantly even if age and gender were cons
i-
dered. The results of the probit analysis suggested that body mass index, high
systolic blood pressure, low diastolic blood pressure, eating habits, physical
activities, smoking, drinking alcohol and sleeping were important factors for
diabetes.
Conclusion: The diabetes might be a costlier disease than previously
thought in Japan. By the estimation, 8% of all medical payments were made
for these persons with diabetes, which is much higher than the result shown
by national survey data. However, overall prevalence could be recused by e
f-
forts such as prevention of overweight and obesity.
Keywords
Diabetes, Medical Cost, Health Checkup, Factors Affecting Diabetes
How to cite this paper:
Nawata, K. and
Kimura
, M. (2017) An Analysis of the Med-
ical
Costs of and Factors Affecting Diabetes
Using the Medical Checkup and Payment
Dataset in J
apan: Can We Reduce the Pre-
valence of Diabetes?
Health
,
9
, 1113-1127.
https://doi.org/10.4236/health.2017.98081
Received:
June 13, 2017
Accepted:
August 4, 2017
Published:
August 7, 2017
Copyright © 201
7 by authors and
Scientific
Research Publishing Inc.
This work is
licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
K. Nawata, M. Kimura
DOI:
10.4236/health.2017.98081 1114 Health
1. Background
As the World Health Organization (WHO) has stated [1] that diabetes is an im-
portant public health problem, one of the four priority noncommunicable dis-
eases targeted by world leaders. WHO [1] also estimated that 422 million adults
or 8.5% of the adult population were living with diabetes in 2014, increased from
108 million or 8.5% of the adult population in 1980. It also estimated 1.5 million
deaths in 2012 due to diabetes and an additional 2.2 million deaths due to the in-
creased risks of cardiovascular and other diseases caused by higher-than-optimal
blood glucose levels. The International Diabetes Federation (IDF) [2] estimated
that the numbers of people (age 20 - 79) with diabetes would increase from 415
million in 2015 to 642 million in 2040. The IDF also estimated that 5.0 million
deaths were caused by diabetes and that the cost of diabetes might have been
between $673 billion and $1197 billion in 2015 ($ refers to US$). NCD Risk Fac-
tor Collaboration [3] studied the trends of the diabetes population since 1980
and concluded that if post-2000 trends would continue, only a limited number
of countries could achieve the global target of halting the rise in the prevalence
of diabetes by 2025. The direct annual global cost of diabetes was estimated to be
$825 billion, led by China ($170 billion), the United States ($105 billion), India
($73 billion), and Japan ($37 billion) based on the number of people with di-
abetes in 2014. The American Diabetes Association (ADA) [4] estimated that the
total cost of diabetes in the United States was $245 billion in 2012.
More recently, Bommer
et al
. [5] estimated that the worldwide cost of diabetes
was $1.31 trillion or 1.8% of the world gross domestic product (GDP) in 2015
(also see Zhang and Gregg [6] for comments on this study). They reported that
two-thirds of the costs were direct medical costs ($857 billion) and one-third
were indirect costs, such as reductions in productivity. Diabetes as a comorbidity
prolongs the length of stay (LOS) in a hospital [7]-[15]. The costs and economic
burden of diabetes are a serious worldwide issue and have been the subject of
various studies [16]-[28]. Diabetes may cause various complications. WHO [1]
stated that “Possible complications include heart attack, stroke, kidney failure,
leg amputation, vision loss and nerve damage.” It has also been pointed out that
diabetes increases the risk of cancer [29] [30].
In Japan, according to a patient survey by the Ministry of Health, Labour and
Welfare [31], the number of diabetes patients treated regularly was 3.16 million
(1.77 million males and 1.40 million females) in 2014, and this number represented
an increase of 0.46 million from the previous survey done in 2011. On the other
hand, the National Health and Nutrition Survey [32] reported that 19.5% of
males and 9.2% of females were living with diabetes in 2015 in Japan. As a result,
the medical costs for diabetes reached 1219 billion yen or 3.0% of Japan’s total
medical expenditure (40.8 trillion yen or 8.33% of Japanese GDP) in fiscal year
2015 (the Japanese fiscal year runs from April to March of the next year) [33].
Nawata and Kawabuchi [34] [35] [36] [37] analyzed the LOS and daily medical
expenditures of type 2 diabetic patients. (Diabetes is classified as type 1 or type 2
K. Nawata, M. Kimura
DOI:
10.4236/health.2017.98081 1115 Health
[38], and 90% or more diabetes cases are classified as type 2 diabetes [38] [39]
[40].) They found that there were large differences in average LOS (ALOS)
among hospitals. On the other hand, the differences in daily medical expendi-
tures among hospitals were relatively small, and ALOS accounted for the largest
part of total medical expenditures for diabetes. The problem with these studies is
that only diabetic inpatients at Diagnosis Procedure Combination (DPC) hospit-
als were analyzed (for details regarding DPC hospitals, see Nawata
et al
. [41]).
The medical expenditures of outpatients and patients in non-DPC hospitals were
not considered. Analyzing all diabetic patients and comparing these patients
with healthy non-diabetic persons are necessary to evaluate the total cost and
economic burden of diabetes. To prevent diabetes, it is also necessary to deter-
mine what factors affect diabetes. For this purpose, it is necessary to investigate a
dataset including normal and healthy persons and compare them with diabetic
persons. However, it is very difficult and costly to get a large scale individual da-
taset that includes many normal and healthy individuals because they do not go
to hospitals or clinics voluntary by themselves. Moreover, whether a person is
diagnosed diabetes or not is a binary variable, and we cannot use the standard
regression analysis.
In Japan, health insurance societies are formed by private companies and cen-
tral and local governments for their employees. The health insurance societies
pay the medical expenses of their members. Moreover, yearly medical checkups
(hereafter, checkups) are required for most workers age 40 or older in Japan
[42]. This means that the health insurance societies have all of the health and
medical information of their members including normal and healthy persons.
The monthly reports of medical payments, including types of treatments, insti-
tutions used and amounts paid for medical care, that are sent from medical in-
stitutes to health insurance societies are called “receipts” in Japan. Nawata
et al
.
[43] and Nawata and Kimura [44] analyzed blood pressures using a dataset con-
taining 113,979 checkups obtained from 48,022 persons with the cooperation of
one health insurance society. However, information from the receipts was not
used in the analysis.
In this paper, we first analyze the total costs of diabetes using the dataset
combining both checkups and receipts. The dataset contains 113,979 checkups
and 3,671,783 monthly medical, dental, care-giving and pharmacy receipts from
fiscal year 2013 to 2015. Since the outcome (diabetes or not) is a binary variable,
we evaluate factors affecting diabetes by the probit models.
2. Data and Analysis
2.1. Data
In this study, we first made up a dataset combining checkups and receipts with
the cooperation of the health insurance society of one large Japanese corporation.
The dataset was anonymized at the society. The dataset contained information
regarding checkups [43] [44] and all receipts from fiscal year 2013 to fiscal year
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