[[alternative]]Healthcare Utilization by Patients with Diabetes and Diabetic Retinopathy among National Health Insurance Enrollees in Taiwan

[[abstract]]目標：過去，有關糖尿病視網膜病變的研究多屬於以醫院為基礎，或是針對特定地區為主的區域型研究，缺乏全面性之探討；因此，本研究欲利用全民健保資料庫來觀察與分析台灣地區糖尿病視網膜病變患者之疾病及醫療費用關係。方法：採橫斷性研究，從2004年國家衛生研究院全民健康保險學術資料庫中根據ICD-9-CM診斷碼及降血糖藥品碼精確篩選出糖尿病患者4,988人、視網膜病變患者1,216人進行統計分析。結果：台灣地區2004年糖尿病視網膜病變病患平均總醫療費用為128,661元，為無合併視網膜病變患者的2.02倍；其中，門診次數每年平均36.9次高於無視網膜病變患者9.6次，住院天數平均6.9天亦高於無視網膜病變患者2.3天。結論：有視網膜病變併發症的糖尿病患，在總醫療費用、門診次數、住院天數均高於沒有視網膜病變的糖尿病患，並且隨著視網膜病變的嚴重度增加而提升醫療資源耗用。因此，由本研究可得知及早預防視網膜病變的發生與治療現網膜病變的併發症，對台灣地區糖尿病患者醫療費用的減少，有相當的助益與實證。[[abstract]]Objectives: In the past decades, most diabetic retinopathy research included either hospital-based or regional studies with few population-based and comprehensive studies. Therefore, a cross-sectional study in Taiwan was conducted to investigate the health expenditure and associated factors amongst adult diabetics in 2004, including those with diabetic retinopathy. Methods: Data from the National Health Insurance Academic Database in 2004 identified 4,988 diabetics along with 1,216 patients with diabetic retinopathy based upon ICD-9-CM and drug codes. Results: The average total medical expenditure of diabetic patients with diabetic retinopathy was 128,661 NT dollars in 2004, which was 2.02-fold higher than that of diabetic patients without diabetic retinopathy. In addition, the average number of outpatient department (OPD) visits by diabetic patients with diabetic retinopathy was 36.9, which is again higher than those without diabetic retinopathy. Finally, the average length of hospital stay for patients with diabetic retinopathy was longer than those without diabetic retinopathy (6.9 days versus, respectively). Conclusions: In this study, adults with diabetic retinopathy, who were NHI enrollees, were consistently more expensive than diabetic adults without diabetic retinopathy. This nationwide, population-based study provides strong evidence that controlling the severity and comorbidity of diabetes along with its associated complications such as diabetic retinopathy is worthy in terms of medical expenditure, OPD visits, and length of hospital stay