PDF(Pubmed)
Abstract：
BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system.
METHODS: We selected three hospitals from each of Mexico\'s main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016.
RESULTS: The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions\' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses.
CONCLUSIONS: The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.
METHODS: We selected three hospitals from each of Mexico\'s main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016.
RESULTS: The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions\' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses.
CONCLUSIONS: The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.
摘要：
背景：门诊护理敏感疾病（ACSC）的住院会给卫生系统带来巨大的成本，而通过适当的门诊护理可以部分避免。慢性疾病的并发症，如糖尿病（DM），被认为是ACSC。先前的研究表明，由于糖尿病而住院具有重大的经济负担。在墨西哥,DM是一个主要的健康问题和死亡的主要原因，但证据有限.这项研究旨在估计墨西哥公共卫生系统中与DM相关的ACSC住院的直接费用。
方法：我们从墨西哥的主要公共机构中选择了三家医院：墨西哥社会保障研究所（IMSS），卫生部（MoH），和国家工人社会保障和服务研究所(ISSSTE)。我们从医疗保健提供者的角度采用了自下而上的微观成本方法来估算与DM相关的ACSC的住院总直接成本。有关停留时间(LoS)的输入数据，协商,药物,胶体/晶体溶液，程序,和实验室/医学成像研究来自2016年期间,在总共1,803例DM相关ACSC(ICD-10编码)出院中,有532例住院治疗的随机样本的临床记录.
结果：每个与DM相关的ACSC住院的平均费用因机构而异，从卫生部的1,427美元到IMSS的1,677美元和ISSSTE的1,754美元不等。三大机构最大的支出是LoS和程序。外周循环和肾脏并发症是DM相关ACSC患者住院费用的主要驱动因素。在这三个机构中，与DM相关的ACSC住院的直接费用占用于健康和社会服务的国内生产总值（GDP）的1％，占医院护理总费用的2％。
结论：与DM相关的ACSC住院的直接费用在各个机构之间差异很大。不同机构之间相同ACSC的此类成本差异表明，基层和医院环境（流程和资源利用）之间的护理质量存在潜在差异，应进一步调查，以确保最佳的供应利用率。糖尿病患者外周循环和肾脏并发症的预防措施可能非常有益。
方法：我们从墨西哥的主要公共机构中选择了三家医院：墨西哥社会保障研究所（IMSS），卫生部（MoH），和国家工人社会保障和服务研究所(ISSSTE)。我们从医疗保健提供者的角度采用了自下而上的微观成本方法来估算与DM相关的ACSC的住院总直接成本。有关停留时间(LoS)的输入数据，协商,药物,胶体/晶体溶液，程序,和实验室/医学成像研究来自2016年期间,在总共1,803例DM相关ACSC(ICD-10编码)出院中,有532例住院治疗的随机样本的临床记录.
结果：每个与DM相关的ACSC住院的平均费用因机构而异，从卫生部的1,427美元到IMSS的1,677美元和ISSSTE的1,754美元不等。三大机构最大的支出是LoS和程序。外周循环和肾脏并发症是DM相关ACSC患者住院费用的主要驱动因素。在这三个机构中，与DM相关的ACSC住院的直接费用占用于健康和社会服务的国内生产总值（GDP）的1％，占医院护理总费用的2％。
结论：与DM相关的ACSC住院的直接费用在各个机构之间差异很大。不同机构之间相同ACSC的此类成本差异表明，基层和医院环境（流程和资源利用）之间的护理质量存在潜在差异，应进一步调查，以确保最佳的供应利用率。糖尿病患者外周循环和肾脏并发症的预防措施可能非常有益。
