Total cost and change in diabetes treatment cost
This study included 1863485 patients with diabetes in Jilin Province in 2016-2019 and 1690972 outpatients and 172513 hospitalized patients. The total cost of diabetes treatment increased from 2.348 billion yuan in 2016 to 2.833 billion yuan in 2019, with an average annual growth rate of 6.46%. The proportion of the total treatment cost increased from 4.26% to 7.14%. Among them, outpatient expenses increased from 1.574 billion yuan to 1.711 billion yuan, and hospitalization expenses increased from 774 million yuan to 1.122 billion yuan (see Table 1).
Table 1 Total change in diabetes treatment costs in Jilin Province from 2016-2019
|
Number of visits
|
Diabetes treatment cost (ten million yuan)
|
Total treatment cost(ten million yuan)
|
Percent of Total treatment cost (%)
|
2016
|
Outpatient
|
603342
|
15.74
|
202.34
|
7.78
|
Hospitalization
|
23174
|
7.74
|
348.59
|
2.22
|
Total
|
626516
|
23.48
|
550.93
|
4.26
|
2017
|
Outpatient
|
396091
|
24.97
|
218.00
|
11.45
|
Hospitalization
|
72713
|
9.03
|
375.64
|
2.40
|
Total
|
468804
|
34.00
|
593.64
|
5.73
|
2018
|
Outpatient
|
404012
|
22.83
|
236.77
|
9.64
|
Hospitalization
|
36416
|
10.89
|
423.64
|
2.57
|
Total
|
440428
|
33.72
|
660.41
|
5.11
|
2019
|
Outpatient
|
287527
|
17.11
|
676.98
|
2.53
|
Hospitalization
|
40210
|
11.22
|
280.36
|
4.00
|
Total
|
327737
|
28.33
|
396.62
|
7.14
|
The total cost of diabetes treatment in Jilin is grouped by age
The treatment cost of diabetes is grouped according to the age of the patients. After 45 years of age, the cost of diabetes treatment is obviously increased, the treatment cost of the 60- to 64-year-old age group is the highest, and the outpatient expenses are much higher than the hospitalization expenses. Outpatient expenses increased gradually from 2016 to 2019. However, according to age group, the cost of outpatient treatment for patients over the age of 55 increased annually, and the outpatient treatment cost of 0-54-year-old diabetic patients showed a downward trend. This result demonstrates that the trend of diabetes outpatient treatment has become an ageing trend in recent years and indirectly reflects the weakening trend of diabetes among the younger population. From the perspective of hospitalization expenses, the cost of hospitalization for diabetes in all age groups showed a slow upward trend (see Table 2).
Table 2 Diabetes treatment cost by age (ten million yuan)
|
2016
|
2017
|
2018
|
2019
|
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
0-4
|
0.09
|
0.04
|
0.03
|
0.02
|
0.03
|
0.03
|
0.07
|
0.07
|
5-9
|
0.01
|
0.01
|
0.02
|
0.01
|
0.01
|
0.01
|
0.01
|
0.02
|
10-14
|
0.03
|
0.02
|
0.04
|
0.02
|
0.02
|
0.04
|
0.02
|
0.04
|
15-19
|
0.04
|
0.03
|
0.05
|
0.04
|
0.03
|
0.05
|
0.02
|
0.05
|
20-24
|
0.04
|
0.06
|
0.05
|
0.09
|
0.03
|
0.07
|
0.04
|
0.11
|
25-29
|
0.12
|
0.17
|
0.22
|
0.15
|
0.40
|
0.22
|
0.10
|
0.33
|
30-34
|
0.20
|
0.22
|
0.33
|
0.23
|
0.30
|
0.31
|
0.24
|
0.51
|
35-39
|
0.38
|
0.28
|
0.55
|
0.31
|
0.52
|
0.46
|
0.34
|
0.47
|
40-44
|
0.70
|
0.40
|
0.79
|
0.42
|
0.71
|
0.52
|
0.56
|
0.52
|
45-49
|
2.03
|
0.70
|
2.00
|
0.86
|
1.77
|
1.08
|
1.07
|
0.99
|
50-54
|
2.25
|
1.13
|
3.25
|
1.29
|
2.80
|
1.47
|
1.86
|
1.33
|
55-59
|
2.60
|
1.12
|
4.26
|
1.35
|
3.89
|
1.73
|
2.94
|
1.76
|
60-64
|
2.88
|
1.26
|
4.79
|
1.47
|
4.44
|
1.72
|
3.33
|
1.66
|
65-69
|
2.02
|
0.94
|
4.18
|
1.17
|
3.93
|
1.50
|
3.08
|
1.49
|
70-74
|
1.03
|
0.62
|
2.24
|
0.71
|
2.17
|
0.85
|
1.71
|
0.91
|
75-79
|
0.90
|
0.41
|
1.29
|
0.42
|
1.06
|
0.47
|
0.90
|
0.51
|
80+
|
0.44
|
0.33
|
0.88
|
0.46
|
0.72
|
0.38
|
0.83
|
0.44
|
合计
|
15.74
|
7.74
|
24.97
|
9.03
|
22.83
|
10.89
|
17.11
|
11.21
|
Average time of diabetes treatment change by age
The average treatment cost for each age group did not significantly differ, but the hospitalization cost was much higher than the outpatient cost. According to the average cost of treatment for each outpatient clinic, the cost for the 0-30-year-old age group remained basically unchanged, and the cost for the 30-year-old age group showed a slow upward trend. The average cost of diabetes treatment decreased annually (see Table 3).
Table 3 Average time of diabetes treatment by age (ten thousand yuan)
|
2016
|
2017
|
2018
|
2019
|
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
Outpa
tient
|
Hospitali
zation
|
0-4
|
0.76
|
2.64
|
0.10
|
1.89
|
0.73
|
2.23
|
0.19
|
2.89
|
5-9
|
0.19
|
2.12
|
0.39
|
1.60
|
0.28
|
1.69
|
0.16
|
1.67
|
10-14
|
0.43
|
2.13
|
0.65
|
1.87
|
0.67
|
2.03
|
0.22
|
1.78
|
15-19
|
0.61
|
2.54
|
0.57
|
2.37
|
0.52
|
2.03
|
0.29
|
2.06
|
20-24
|
0.32
|
3.27
|
0.38
|
1.19
|
0.48
|
2.24
|
0.31
|
2.87
|
25-29
|
0.31
|
2.71
|
0.55
|
1.54
|
1.58
|
2.11
|
0.29
|
2.77
|
30-34
|
0.33
|
2.68
|
0.50
|
1.41
|
0.55
|
2.17
|
0.39
|
2.89
|
35-39
|
0.34
|
2.77
|
0.55
|
1.38
|
0.57
|
2.66
|
0.42
|
2.60
|
40-44
|
0.37
|
3.00
|
0.59
|
1.45
|
0.54
|
2.65
|
0.52
|
2.55
|
45-49
|
0.15
|
3.05
|
0.62
|
1.36
|
0.58
|
2.96
|
0.56
|
2.65
|
50-54
|
0.37
|
3.15
|
0.64
|
1.28
|
0.58
|
2.98
|
0.61
|
2.68
|
55-59
|
0.37
|
3.36
|
0.66
|
1.13
|
0.57
|
3.00
|
0.63
|
2.70
|
60-64
|
0.36
|
3.48
|
0.65
|
1.17
|
0.57
|
3.18
|
0.66
|
2.86
|
65-69
|
0.37
|
3.69
|
0.66
|
1.20
|
0.56
|
3.26
|
0.65
|
2.91
|
70-74
|
0.36
|
3.95
|
0.64
|
1.12
|
0.55
|
3.46
|
0.62
|
3.07
|
75-79
|
0.08
|
3.80
|
0.62
|
1.21
|
0.48
|
3.17
|
0.56
|
2.89
|
80+
|
0.35
|
4.38
|
0.57
|
1.47
|
0.46
|
3.56
|
0.58
|
3.35
|
合计
|
0.26
|
3.34
|
0.63
|
1.24
|
0.57
|
2.99
|
0.60
|
2.79
|
Changes in average cost composition
In 2016-2019, the average outpatient expenses for diabetes in Jilin increased from 240.53 yuan to 304.61 yuan, corresponding to an average annual increase of 8.19%, and all expenses showed an upward trend. From the perspective of cost composition, the costs primarily consisted of drug, laboratory and treatment costs. The proportion of drug cost decreased from 95.32% to 87.15%, the laboratory cost increased from 2.07% to 5.20%, and the treatment cost increased from 1.30% to 3.76% over this period. Despite the rapid growth of other expenses, the proportion remained low (see Table 4).
Table 4 Average outpatient expenses for diabetic patients in Jilin (yuan)
|
2016
|
2017
|
2018
|
2019
|
Average annual growth rate
|
Average outpatient expenses
|
240.53
|
278.72
|
343.45
|
304.61
|
8.19
|
Treatment fee
|
3.12
|
5.65
|
8.50
|
11.44
|
54.21
|
Drug cost
|
229.26
|
261.62
|
313.53
|
265.48
|
5.01
|
Inspection fee
|
1.18
|
2.02
|
6.07
|
5.38
|
65.54
|
Examination fee
|
1.41
|
1.94
|
2.06
|
4.65
|
48.84
|
Operation cost
|
0.18
|
0.24
|
0.36
|
0.59
|
49.66
|
Assay fee
|
4.97
|
6.48
|
12.25
|
15.83
|
47.09
|
Registration fee
|
0.40
|
0.76
|
0.66
|
1.25
|
45.92
|
In 2016-2019, the average hospitalization expenses associated with diabetes in Jilin Province decreased from 7280.63 yuan to 6707.33 yuan, corresponding to a decrease of 2.70%. The proportion of drug and treatment fees also decreased by 6.20% and 10.29%, respectively, while that for all other constituent items increased. However, the proportion of the average cost still decreased as a result of the small proportion (see Table 5).
Table 5 Average hospitalization expenses for diabetic patients in Jilin (yuan)
|
2016
|
2017
|
2018
|
2019
|
Average annual growth rate
|
Average hospitalization expenses
|
7280.63
|
6334.69
|
7071.47
|
6707.33
|
-2.70
|
Treatment fee
|
1042.86
|
1165.12
|
1783.29
|
860.72
|
-6.20
|
Drug cost
|
3443.22
|
2927.58
|
2781.16
|
2486.26
|
-10.29
|
Inspection fee
|
814.09
|
501.36
|
613.94
|
837.39
|
0.94
|
Consultation fee
|
59.20
|
175.40
|
134.96
|
170.97
|
42.41
|
Operation cost
|
186.63
|
90.05
|
208.43
|
399.71
|
28.90
|
Bed fee
|
307.53
|
388.98
|
320.91
|
374.30
|
6.77
|
Nursing fee
|
123.79
|
173.16
|
350.14
|
204.55
|
18.22
|
Assay fee
|
1303.31
|
913.03
|
878.65
|
1373.44
|
1.76
|
Analysis of the average cost of diabetes in Jilin based on the structural change method
From 2016 to 2019, the structural change degree of average outpatient expenses was 16.32%. From the structural change direction of each expense item, the absolute value of the structural change value of drug expenses from 2016-2019 was the highest, indicating that drug expenses had the greatest impact on the structural change of average outpatient expenses. The structural change value of the second average drug cost was negative, indicating that its proportion had decreased, and the structural change values of other items were positive, indicating that their proportion had increased (see Table 6).
Table 6 VSV and DSV in the average outpatient cost for diabetic patients in Jilin Province
|
VSV(%)
|
DSV
(%)
|
|
Treatment fee
|
Drug cost
|
Inspection fee
|
Examination fee
|
Operation cost
|
Assay fee
|
Registration fee
|
2016-2017
|
0.73
|
-1.45
|
0.23
|
0.11
|
0.01
|
0.26
|
0.11
|
2.90
|
2017-2018
|
0.45
|
-2.57
|
1.04
|
-0.10
|
0.02
|
1.24
|
-0.08
|
5.50
|
2018-2019
|
1.28
|
-4.14
|
0.00
|
0.93
|
0.09
|
1.63
|
0.22
|
8.29
|
2016-2019
|
2.46
|
-8.16
|
1.27
|
0.94
|
0.12
|
3.13
|
0.24
|
16.32
|
From 2016-2019, the subaverage drug cost was the main item causing the change in the subaverage outpatient cost structure, with a contribution rate of 50.2%, followed by the laboratory and treatment fees, with contribution rates of 19.17% and 15.7%, respectively (see Table 7).
Table 7 Contribution rate of structural change (%)
|
Treatment fee
|
Drug cost
|
Inspection fee
|
Examination fee
|
Operation cost
|
Assay fee
|
Registration fee
|
2016-2017
|
25.22
|
50.02
|
8.00
|
3.79
|
0.46
|
8.91
|
3.65
|
2017-2018
|
8.13
|
46.82
|
18.97
|
1.74
|
0.36
|
22.54
|
1.44
|
2018-2019
|
15.45
|
49.91
|
0.04
|
11.17
|
1.06
|
19.67
|
2.61
|
2016-2019
|
15.07
|
50.02
|
7.79
|
5.76
|
0.74
|
19.17
|
1.49
|
From 2016-2019, the average hospitalization cost structure changed greatly, accounting for 23.45%, which was mainly due to the change in the average drug cost structure, indicating that the average drug cost is the main driving factor causing the change in the average cost structure. The second are the average operation and laboratory fees, with structural change values of 3.4% and 2.58%, respectively. In the direction of structural change, the average drug cost over time has been trending in a negative direction, indicating that the proportion of average drug cost over time has decreased annually. Other expense items show positive changes, indicating that the proportion has increased (see Table 8).
Table 8 VSV and DSV in the average hospitalization cost for diabetic patients in Jilin Province
|
VSV(%)
|
DSV
(%)
|
|
Treatment fee
|
Drug cost
|
Inspection fee
|
Consultation fee
|
Operation cost
|
Bed fee
|
Nursing fee
|
Assay fee
|
2016-2017
|
4.07
|
-1.08
|
-3.27
|
1.96
|
-1.14
|
1.92
|
1.03
|
-3.49
|
17.96
|
2017-2018
|
6.83
|
-6.89
|
0.77
|
-0.86
|
1.53
|
-1.60
|
2.22
|
-1.99
|
22.69
|
2018-2019
|
-12.39
|
-2.26
|
3.80
|
0.64
|
3.01
|
1.04
|
-1.90
|
8.05
|
33.09
|
2016-2019
|
-1.49
|
-10.23
|
1.30
|
1.74
|
3.40
|
1.36
|
1.35
|
2.58
|
23.45
|
From 2016-2019, the average drug cost was the main factor causing the change in the average hospitalization cost structure, with a contribution rate of 43.6%, followed by the average operation and laboratory costs, with contribution rates of 14.48% and 1.98%, respectively. (see Table 9)
Table 9 Contribution rate of structural change (%)
|
Treatment fee
|
Drug cost
|
Inspection fee
|
Consultation fee
|
Operation cost
|
Bed fee
|
Nursing fee
|
Assay fee
|
2016-2017
|
22.66
|
6.00
|
18.19
|
10.89
|
6.36
|
10.67
|
5.75
|
19.42
|
2017-2018
|
30.08
|
30.35
|
3.38
|
3.79
|
6.72
|
7.06
|
9.77
|
8.76
|
2018-2019
|
37.43
|
6.83
|
11.49
|
1.94
|
9.10
|
3.15
|
5.75
|
24.33
|
2016-2019
|
6.36
|
43.60
|
5.56
|
7.40
|
14.48
|
5.78
|
5.75
|
10.98
|