Costos de atención médica de personas con diabetes anteriores y posteriores a su hospitalización en Argentina

Abstract

To analyze and compare the ambulatory care expenditures for persons with diabetes during prehospitalization and posthospitalization periods with those of diabetics who were not hospitalized for diabetes-related illnesses during the same period. We determined the hospitalization and ambulatory care expenses incurred by an Argentine health insurer for the hospitalization of diabetic clients during the study period, and compared these expenses to the expenses of insured diabetics who were not hospitalized during that period. We identified 2,760 persons with diabetes (2.4% of the total number of persons covered by the insurance company). Of those, 1,683 (59%) were on medication for diabetes and its associated cardiovascular risk factors. Diabetes was associated with either one (41%) or two (24%) cardiovascular risk factors. Of those 1 683 persons, 102 (6%) were hospitalized for diabetes-related reasons during the study period. The frequency of hospitalization increased significantly in cases where diabetes was associated with arterial hypertension and dyslipidemia. Cardiovascular illness was the cause of 43.1% of the hospitalizations, with a significantly higher per capita cost than any of the other causes identified (mean +/- standard error of the mean: US 1,673 dollars +/- US 296.8 dollars; P < 0.05). The total annual per capita cost for health care for the diabetics who had been hospitalized was greater than for those who had not (US 2,907.8 dollars +/- US 262.5 dollars compared to US 473.4 dollars +/- US 9.8 dollars, respectively; P < 0.01). While the total posthospitalization ambulatory care expenditures were 12% higher than the prehospitalization costs (US 903.6 dollars +/- US 108.6 dollars vs. US 797.6 dollars +/- US 14.9 dollars), the difference was not significant. Ambulatory care expenditures increase significantly in the prehospitalization and posthospitalization periods. The results suggest that intensive treatment of hyperglycemia and its associated cardiovascular risk factors may prevent hospitalization and is a more cost-effective option than hospitalization and posthospitalization ambulatory care.