Full
Outline
To investigate the influencing factors of outpatient expenses for diabetic patients and conduct case-mix grouping and expenses estimation, providing evidence for the reform of outpatient medical insurance payment methods.
Outpatient medical insurance settlement data of diabetic patients from tertiary hospitals in Lanzhou between January 2022 and December 2023 were collected. Univariate analysis and multivariable linear regression models were used to analyze the influencing factors of total outpatient medical expenses. Subsequently, a decision tree model was applied for ambulatory patient groups(APG) classification, and relevant indicators were employed to evaluate APGs and estimate expenses.
A total of 48 948 valid records were included. The total outpatient medical expenses of diabetic patients were associated with gender (Z=-5.702, P<0.001), ethnicity (Z=-2.180, P=0.029), age (Z=1 096.615, P<0.001), type of diabetes (Z=1 463.467, P<0.001), complications (Z=-13.593, P<0.001), medication use (Z=-10.370, P<0.001), diagnostic testing (Z=-4.676, P<0.001), and medical consumables usage (Z=-16.509, P<0.001). Higher outpatient expenses were observed in male patients, other ethnic groups, individuals aged <45 years, type 2 diabetes cases, and patients with complications, medication use, diagnostic testing, and medical consumables usage. Based on the decision tree model, 13 APGs were established. The number of cases per APG group ranged from 114(APG8) to 11 619(APG5), with significant differences among groups based on a nonparametric test(H=3 266.675, P<0.001). The reduction in variance (RIV) was 0.945, the coefficient of variation (CV) ranged from 0.93 (APG2)to 1.56 (APG12), the relative weight (RW) ranged from 0.44 (APG11) to 1.69 (APG1), the standardized cost ranged from 58.55 CNY (APG12) to 324.83 CNY (APG1), and the excess cost ratio ranged from 1.81%(APG1) to 8.93% (APG3).
The economic burden of outpatient diabetes in tertiary hospitals is substantial, with significant cost variations among different patient subgroups. The decision tree-based case-mix grouping performed well, demonstrating strong inter-group heterogeneity and good intra-group homogeneity. It is recommended to strengthen outpatient security and precise cost control, optimize diagnosis and treatment as well as precise classification of disease groups, and build a diversified and precise payment system, so as to promote the optimization of outpatient medical insurance payment methods and reduce the medical burden of diabetic patients.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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