| Background Information1. The cost of diabetesSince the threat and medical burden of chronic disease in the world aggravate increasingly, the risk management of chronic disease becomes an urgent task. "Chinese Chronic Disease Report" from Ministry of Health of China points out that 7,500,000 Chinese die of chronic disease, and China may become "a chronic disease country". With the change of economic environment, population form and life style, the rising rate of getting diabetes in our country increases quickly. The rate of getting diabetes was 0.61% in 1980, while it increased to be 3.2% in 1995. And it takes 35 years for American to reach the same increasing rate. Because of the big base of Chinese population, China has become the second largest country of diabetes patients. Daqing Diabetes Prevention Research discovery that the changing speed from IGT crowd to 2 type diabetes patients is very quick in China and the transfer from diabetes with no complication to diabetes with complication also accelerates. It becomes a big challenge for entire medical system because the large quantity of diabetic patients with complications consumes a plenty of medical resources. Based on the points mentioned above, diabetes has become a major social problem that influences people's health. In the future of 10 years, diabetes will be a challenge for family life, personal health as well as the social economy. As the theme of World Diabetes Day, "the cost of diabetes" needs more attention from the whole society.2. The difficulty in researchMedical economy begins after the year of 1950. In 1966, the American medical economist Rice published "The Calculation of Disease Cost". Then in 1967, Rice, together with Cooper, put forward the method of calculating disease cost in the published book "The Economic Value of Human Life". In 1996, the first conference of International Health Economy Association was hold in Vancouver, Canada. The conference discussed the problems about raising funding of medical care and the cost of medical care as well as the study of POHEM. In 13th June, 2005, the 65th annual conference in American Diabetes Association reported the result of health economic analysis. It predicted that according to "the Swiss CORE diabetes forecast model", the American economy can save 72 billion dollars if diabetes patients in America follow the current principles of treatment.One research difficulty is: it is expensive and difficult to get the reliable sample data. Because of the big mobility of patients between hospitals, there is a limitation in the epidemiological investigation in one certain hospital. Without a lot of manpower and material resources, the data will not be objective and complete. Another difficulty lies in the abuse of too many departments and agencies in health service. Therefore, it may be difficult to share data and resource among them.The challenge which the Ministry of Public Health is faced with is the lack of reliable evidence for health system and population healthy pattern and the lack of the coordinative developments between departments. This has also formed the background situation to develop the macro-economics and health work in China.3. The mission and opportunity of social medical care assurance systemThe biggest pressure in medical insurance department is how to maintain a balanced account. Also, it is an important topic about how the cumulative effects of chronic disease affect medical insurance funding. In fact, medical insurance has brought unprecedented opportunity to the research of epidemiology and medical economics. What needs the entire country to consider fully is how to use the data of medical insurance and how to make these data receive more effective uses. OBJECTIVESThis paper aims at investigating the data of diabetes and structure of current medical insurance, analyzing the distribution rules and correlation factors of diabetes charges, and checking the diabetic and prediabetic patients in order to offer basis to the collocation of diabetic charges and establishment of the standard data in medical insurance. The article also mirrors the standard data in medical insurance throughout the country. And it may offer certain references to the management of other chronic diseases.RESEARCH METHODS1. With the retrospective method: to analyze the medical cost of type 2 diabetic patients in one certain city's medical insurance between 2003 and 2005, and to find out the distribution features of diabetes and its complication so that the certain standard can be offered to the early intervention of diabetes.2.With the linear regression method: to study the factors related to medical cost among diabetic patients in one certain hospital from 1998 to 2002, and to produce equation of linear regression, then find out the main factors related to the medical cost so that the monitoring index and means for the early intervention can be provided.3. With cross-sectional study: to check the diabetic and prediabetic patients in one certain hospital during 8th November, 2004 to 13th November, 2004 and to explore the essentiality of early intervention measure such as prediabetic screening and health education.4. Based on the conclusions of the above three aspects, the article aims at putting forward the intervention measure of medical insurance for diabetes management.5. Based on the existed problems of the above three aspects, the article aims at introducing a new scheme about the structure of diabetes cost.RESULTS1. The current economic situation of diabetes in medical insurance in Guangzhou has the following characteristics:(1) The hospitalization rate of retired people exceeds the hospitalization rate ofworking people. (2) The distribution of diabetes cost follows certain rules.(3) The specific program of out-patient department restrains the diabetes hospitalization expenses and the diabetes medical cost in total.2. The analysis of the key factors in diabetes hospitalization expense in a First Class of the third Grade Hospital indicates that:(1) The key factor which affects the single hospitalization expenses of diabetes is diabetes complication. The treatment cost of patients who with complication is obviously higher than the one without complication.(2) Different complications may have influence on patients' single hospitalization expenses at different degrees.(3) There exist obvious differences among the various complication patients' single average hospitalization expenses.3. The existed problems:1) There is no standard rule for discharge diagnosis of diabetes.2) Some doctors and most patients do not pay enough attention to the early stage of diabetes.CONCLUSIONS1. There exists the cumulative effect in diabetes. Therefore, when keeping balance of medical insurance Found, we must take fully consideration about the cumulative effect between diabetes and other chronic diseases.2. The distribution of diabetes medical cost follows "two-eight rule": in the expense of diabetes hospitalization, 50% of the medical costs are concentrated on the 20% key patients who spend higher medical expense, and 35% of the medical expenses even concentrate on the 10% patients that spend high expense. So it will be a very effective means to analyze the key patients' medical expense and try to find out the possible measures to prevent and control the disease.3. The specific program of diabetes OPD interferes efficiently in the hospitalization expenses of diabetes and has certain restriction on the total medical expense.4. The adjustment of payment standard in hospitalization has influenced the patients' choice of ranked hospital. Medical treatment is viewed as a special product. What patients emphasize more is the quality of medical treatment. Without the promotion of the technical quality of the first class or second class hospital, patients will not really change their choices of hospital.5. From the cross-sectional study, new diagnosis diabetes patients have exceeded to the old ones. This finding infer that we should pay more attention to the sensitive group who are likely to been infect with diabetes, such as hypertension patient and fat crowd.6. A part of newly diagnosed diabetes may already complicated by nephropathia, so the early screening have positive influence on controlling the complications.SCHEMEIn order to make the maximum efficacy of medical insurance resource and reduce the payment of medical insurance resource, the article provides the group basis, monitoring method and intervention means to the early intervention of diabetes—enhancing the research of the specific program in out-patient service; improving the medical treatment quality of First Class and Second Class Hospital as well as the District Hospital; strengthening the management of diabetes expense by standardizing the health education, diabetes treatment and management.To make the diabetes data more valued, the essay suggests that the diabetes data should contain the following additional factors: (1) to give specific definition of discharge diagnosis including diabetes complication and diagnosis time; (2) to add blood sugar, glycosylated hemoglobin, the level of insulin and the level of C peptid into diabetes reported data.The article mirrors the standard data in medical insurance throughout the country and may give certain reference to the management of the other chronic diseases.
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