Characteristics of Type-2 Diabetics Who are Prone to High-Cost Medical Care Expenses by Bayesian Network

International Journal of Environmental Research and Public Health

Teppei Suzuki¹  Yuji Tani²  Takumi Tanikawa³  Hiroko Yamashina⁴  Katsuhiko Ogasawara⁴  Yuji Sase⁵  Kensuke Fujiwara⁶  Hisashi Enomoto⁷  Wataru Nagai⁷  Takeshi Aoyama⁷  Daiki Kumagai⁸ 

[1] Art & Sports Business, Iwamizawa, Hokkaido University of Education, Hokkaido 068-8642, Japan;Department of Medical Informatics and Hospital Management, Asahikawa Medical University, Hokkaido 078-8510, Japan;Faculty of Health Sciences, Hokkaido University of Science, Hokkaido 006-8585, Japan;Faculty of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;Faculty of Medical Informatics, Hokkaido Information University, Hokkaido 069-8585, Japan;Graduate School of Commerce, Otaru University of Commerce, Hokkaido 047-8501, Japan;Iwamizawa City, Hokkaido 068-0828, Japan;School of Health Sciences, Hokkaido University, Hokkaido 060-0812, Japan;

关键词: health economics;    bayesian network;    diabetes;    National Health Insurance;    medical costs;    specific health checkups;   

DOI  :  10.3390/ijerph17155271

来源: DOAJ

【 摘 要 】

Objective: This study aims to determine the characteristics of Type 2 diabetic patients who are more likely to cause high-cost medical expenses using the Bayesian network model. Methods: The 2011–2015 receipt data of Iwamizawa city, Japan were collected from the National Health Insurance Database. From the record, we identified patients with Type 2 diabetes with the following items: age, gender, area, number of days provided medical services, number of diseases, number of medical examinations, annual healthcare expenditures, and the presence or absence of hospitalization. The Bayesian network model was applied to identify the characteristics of the patients, and four observed values were changed using a model for patients who paid at least 3607 USD a year for medical expenses. The changes in the conditional probability of the annual healthcare expenditures and changes in the percentage of patients with high-cost medical expenses were analyzed. Results: After changing the observed value, the percentage of patients with high-cost medical expense reimbursement increased when the following four conditions were applied: the patient “has ever been hospitalized”, “had been provided medical services at least 18 days a year”, “had at least 14 diseases listed on medical insurance receipts”, and “has not had specific health checkups in five years”. Conclusions: To prevent an excessive rise in healthcare expenditures in Type 2 diabetic patients, measures against complications and promoting encouragement for them to undergo specific health checkups are considered as effective.

【 授权许可】

Unknown