Study on the Effects of Outpatient Medication Security on Elderly Patients with Hypertension and Diabetes&#x02014;&#x02014;Based on Real-World Data of Medical Insurance from 2019 to 2023

doi:10.19546/j.issn.1674-3830.2024.7.002

China Health Insurance ›› 2024, Vol. 0 ›› Issue (7) : 11-23. DOI: 10.19546/j.issn.1674-3830.2024.7.002

Study on the Effects of Outpatient Medication Security on Elderly Patients with Hypertension and Diabetes——Based on Real-World Data of Medical Insurance from 2019 to 2023

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Abstract

Objective: Early outpatient medication is a critical means for the treatment and control of the progression of chronic diseases such as hypertension and diabetes. This study attempts to characterize the outpatient drug consumption of elderly patients with hypertension and diabetes under the outpatient security policy, and to analyze the effects of outpatient medication on inpatient service utilization and costs. Methods: Basic medical insurance participation and claim data of all insured residents in W city from 2019 to 2023 were collected. Elderly patients with hypertension and/or diabetes who are entitled to the outpatient chronic and special disease medical security policy and have visiting records at designated medical institutions were selected as study samples, dividing into three groups of people with different types and levels of medical insurance (residents level 1, residents level 2, and employees). The two-way fixed-effect model was constructed, with inpatient service utilization and cost indicators as the dependent variables, outpatient medication frequency and extent as the independent variables. Results: 140283 elderly patients with hypertension and diabetes were included, with an average age of 72.2±7.7 years old. Most patients had an average outpatient medication frequency of greater than or equal to 4 visits per year, the annual outpatient drug costs per capita decreased from 1848.6 yuan in 2019 to 888.3 yuan in 2023, and the annual outpatient medication frequency and outpatient medication costs show a trend of "residents level 1<residents level 2<employees", with total outpatient drug costs accounting for 96.1%. The probability, frequency, and length of hospitalization significantly decreased with the increase of outpatient medication frequency and extent (P<0.01), which is consistent among people with different levels of medical insurance. Inpatient medical costs and drug costs decreased significantly in the group with higher outpatient medication frequency (P<0.01), but showed an inverted U-shaped distribution with the increase of outpatient medication extent. Conclusion: The core outpatient demand of elderly patients with hypertension and diabetes is medication, and their medication utilization varies by medical insurance levels, comorbidities, and complications. Under the outpatient security mechanism of chronic disease, guiding adequate and rational outpatient medication is conducive to the “replacement effect” on inpatient medical services and the decrease of inpatient costs.

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outpatient medication security / hypertension / diabetes / the elderly

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Study on the Effects of Outpatient Medication Security on Elderly Patients with Hypertension and Diabetes——Based on Real-World Data of Medical Insurance from 2019 to 2023[J]. China Health Insurance. 2024, 0(7): 11-23 https://doi.org/10.19546/j.issn.1674-3830.2024.7.002

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