Medical Care and Payment for Diabetes in China: Enormous Threat and Great Opportunity

Abstract

BackgroundThe Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care.MethodsIn 2009–10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%.FindingsAfter adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥10 years prior to the survey paid 3.75 times as much for medical care as those with ≤5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination.ConclusionsIn China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used.

Hyperglycemia and duration of diabetes as risk factors for abnormal lipids: a cross sectional survey of 19,757 patients with type 2 diabetes in China

“…In the Hong Kong Diabetes Registry, \15 % of the patients were using lipid lowering drugs at baseline [30]. In contrast, a large survey in China showed that only 1.9 % of Chinese with diabetes in the urban areas used lipid lowering drugs, including that 1.7 % used statins [31]. The users of lipid lowering drugs without CVD and hyperlipidemia in this study might only account for a small proportion of the total sample.…”

The Efficacy and Safety of Chinese Herbal Decoction in Type 2 Diabetes: A 5‐Year Retrospective Study

“…It has been estimated that a total of 12.9 million people died from ischemic heart disease and stroke in the world, while diabetes is the main risk factor [5, 6]. Studies have shown that good glycemic control is critical for patients with type 2 diabetes mellitus (T2DM), since the HbA1c level is correlated with diabetic complications [7, 8]. However, according to the latest survey among 22.31 million Chinese T2DM patients, it was shocking that more than two-thirds could not effectively control their HbA1c levels [9].…”

An economic evaluation for prevention of diabetes mellitus in a developing country: a modelling study

“…The medical and economic burden of diabetes is an important public health challenge for China. However, at present, there is no systematic prevention strategy for diabetes, despite the fact that it is considered a fundamental component of the nation’s health policies [9]. …”