Factors affecting health-care costs and hospitalizations among diabetic patients in Thai public hospitals.

OBJECTIVE The study investigated the factors affecting health-care costs and hospitalizations among diabetic patients in Thai public hospitals. METHODS A retrospective study was conducted by using administrative claims data obtained from diabetic patients during October 1, 2002 and September 30, 2003. Dependent variables were total health-care costs and the occurrence of hospitalizations. Independent variables included demographic factors, health-care utilisation, complications, comorbidities, and payment methods. Multivariate statistical analyses were applied. RESULTS The results of this study suggested that demographic factors of patients (i.e., age and male sex), payment methods (i.e., capitation, fee-for-service, and out-of-pocket) were significantly associated with higher health-care costs and probability of hospitalization. Patients receiving treatment from teaching hospitals significantly consumed higher health-care costs. In addition, the more health-care utilisation (i.e., occurrence of hospitalization, number of outpatient visit, and insulin utilization), the higher health-care costs the patients significantly had. Diabetic patients taking insulin had significantly higher health-care costs and risk of hospitalization. Furthermore, comorbidities (e.g., hypertension and cancer) and diabetes-related complications (e.g., nephropathy, neuropathy, retinopathy, coronary artery disease, cardiovascular disease, and peripheral vascular disease) were significantly associated with an increase in health-care costs and hospitalization. CONCLUSION Factors affecting health-care costs and hospitalizations may help health-care providers intervene to improve patient management and possibly reduce health-care costs in the future.