Reduced medical spending associated with increased use of a remote diabetes management program and lower mean blood glucose values

Abstract

Aims: Many new mobile technologies are available to assist people in managing chronic conditions, but data on the association between the use of these technologies and medical spending remains limited. As the available digital technology offerings to aid in diabetes management increase, it is important to understand their impact on medical spending. The aim of this study was to investigate the financial impact of a remote digital diabetes management program using medical claims and real-time blood glucose data.

Materials and methods: A retrospective analysis of multivariate difference-in-difference and instrumental variables regression modeling was performed using data collected from a remote digital diabetes management program. All employees with diabetes were invited, in a phased introduction, to join the program. Data included blood glucose (BG) values captured remotely from members via connected BG meters and medical spending claims. Participants included members (those who accepted the invitation, n?=?2,261) and non-members (n?=?8,741) who received health insurance benefits from three self-insured employers. Medical spending was compared between people with well-controlled (BG ≤ 154?mg/dL) and poorly controlled (BG > 154?mg/dL) diabetes.

Results: Program access was associated with a 21.9% (p?<?0.01) decrease in medical spending, which translates into a $88 saving per member per month at 1 year. Compared to non-members, members experienced a 10.7% (p?<?0.01) reduction in diabetes-related medical spending and a 24.6% (p?<?0.01) reduction in spending on office-based services. Well-controlled BG values were associated with 21.4% (p?=?0.03) lower medical spending.

Limitations and conclusions: Remote digital diabetes management is associated with decreased medical spending at 1 year. Reductions in spending increased with active utilization. It will be beneficial for future studies to analyze the long-term effects of the remote diabetes management program and assess impacts on patient health and well-being.     

基于中东欧与独联体国家经验的医疗非正式支付问题浅析

本文以中东欧与独联体国家为例，介绍了这些国家和地区内医疗非正式支付的起源、规模、产生原因、相关评价、治理等内容，并简要介绍了我国的医疗非正式支付现象及治理措施与成果。结果显示，这些国家的医疗非正式支付现象与我国有许多相似之处，他们的治理经验可以为我国提供参考。     

浅谈急诊急救工作及其标准化

阐述急诊急救工作的发展前景，结合省情和急诊急救工作的实际，论述建立急诊急救工作标准化的必要性和若干措施。     

微软“弃权”引发的会计学思考

股票期权一直是高技术公司吸引员工的一大卖点.微软放弃员工股票期权而改用限制性股票作为长期激励手段的＂弃权＂行为,迫使人们去思考一些会计问题：对股票期权应该怎样进行会计确认,会计标准制定机构能否左右会计标准的制定,这些问题的解决过程是股票期权会计处理不断发展的过程.     

高等医学院校医学伦理学教学改革探索

在医学教育中,医学伦理学是必不可少的组成部分。深化医学伦理学教学改革,更新教育理念、创新教学内容、改革教学方法和手段,才能切实提高教学质量,充分发挥医学伦理学的最佳育人功能。     

提高医学院校计算机实验室服务能力的探索——以“人文信息管理实验教学中心”为例

随着计算机和网络技术的迅猛发展,各大高校的计算机实验室的数量与日俱增。除了日常教学、科研外,还兼有了一些社会服务职能。本文以成都医学院"人文信息管理实验教学中心"为例,探讨如何管理好、维护好实验室的财和物等资源,最大程度地发挥高校计算机实验室的服务能力。     

浅谈医院形象与护士素质的关系

医院形象是一个医院是否能生存发展的品牌,是医院巨大的无形资产,护理工作是医疗工作的重要组成部分是医院形象的代表,良好的护士素质、高超的专业技能是患者选择就医的先决条件。     

非农就业、保险选择与土地流转

研究目的:利用中国居民收入调查CHIP2013数据,分析非农就业情景下农民参与不同类别的社会保险对土地流转的影响,探索促进土地流转的改革对策。研究方法:Logit模型。研究结果:农户从事非农工作、非农就业工资高、就业时间长、就业于大城市均能推动土地流转;农民参加城镇居民基本医疗保险会显著提升土地流转的概率,但该提升作用并不受非农就业的影响而改变;新型农村合作医疗保险不利于土地流转,但非农就业下参加新农合养老保险或者商业养老保险会促进土地流转。从区域差别上来看,非农就业下,只有东部、中部农户户主参加居民基本医疗保险对土地流转的作用显著。研究结论:要统筹新农合制度和农地流转政策的目标,不能盲目推进土地流转;要为农民兼业化和外出务工创造良好的条件;针对东中西部的非农就业农户制定不同保险措施,提供农户兼业化或者农民工适合的居民基本养老保险、新农合养老保险或者商业养老保险,排除农民的后顾之忧。     

医疗卫生行业的“分类—分管”管制模式探析

长期以来,我国对医疗卫生领域的全行业管制,采取的是一种"方式单一"且"混业管理"的管制模式.即无论是公共卫生还是医疗服务,统统采用一种管制模式和一套管制制度.然而,医疗卫生服务活动可以明确地区分为公共产品、准公共产品和私人产品.可以根据不同产品的产品性质构建不同的供给模式和管制模式,形成"分类-分管"管制模式.即对于公共卫生领域采取公共供给和政府严格管制模式;对于妇幼保健、特殊疾病的预防与治疗等准公共服务采用政府主导管制模式;而对于医疗服务领域则采用私人供给和"有管制的竞争"模式.这有利于提高卫生管制的针对性和专业化程度,提高政府卫生管制有效性.     

The societal burden of pain in Germany: Health-related quality-of-life,health status and direct medical costs

Abstract

Objectives:

The purpose of this paper is to estimate the impact of the severity and frequency of pain on health-related quality-of-life (HRQoL), self-reported health status, and direct medical costs in Germany.

Methods:

Data are from the internet-based 2010 National Health and Wellness Survey (NHWS). Estimates of the impact of pain experience are generated by a series of regression models. In the case of HRQoL the physical and mental summary scores from the SF-12, together with SF-6D utilities, are evaluated within an ordinary least squares framework. Health status is assessed through an ordered logit model. Direct medical costs are estimated through a semi-logarithmic healthcare cost function. Socioeconomic characteristics, health risk behaviors, and the Charlson Comorbidity Index (CCI) are introduced as control variables in all regressions.

Results:

An estimated 23.96% of the adult German population (16.39 million) reported experiencing pain in the last 30 days. Of these 13.16% reported severe pain. The experience of frequent severe and moderate pain has a significant deficit impact on HRQoL. For those experiencing severe daily pain, the deficit in the SF-12 physical component score (PCS) is ?17.930 (95% CI: ?18.720 to ?17.140), the SF-12 mental component score (MCS) is ?8.787 (05% CI: ?9.857 to ?7.716), and SF-6D absolute utilities ?0.201 (95% CI: ?0.214 to ?0.188); with self-reported health status the deficit impact of severe daily pain is also substantial (OR?=?29.000; 95% CI: 23.000–36.580). In the case of direct medical costs severe daily pain increases healthcare provider costs by 101.6% and total direct costs by 123.9%.

Limitations:

The NHWS is an internet survey. The principal limitation is that as a self-report there is no separate validation of pain severity or chronicity.

Conclusions:

The experience of pain has a substantial negative impact on HRQoL, health status, and resource utilization in Germany. If pain is considered as a disease in its own right, the experience of chronic pain presents policy-makers with a major challenge.