An estimation of the effect of 100% Compliance with Diabetes Treatment: Can we reduce cost of illness with higher compliance rates?

Introduction: The current study was designed to estimate the direct cost of noncompliance of diabetes patients to the US health system. Understanding these expenses can inform screening and education budget policy regarding expenditure levels that can be calculated to be cost-beneficial. Materials and Method: The study was conducted in three parts. First, a computer search of National Institutes of Health websites and professional society websites for organizations with members that treat diabetes, and a PubMed search were performed to obtain the numbers required for calculations. Second, formulas were developed to estimate the risk of non-compliance and undiagnosed diabetes. Third, risk calculations were performed using the information obtained in part one and the formulas developed in part two. Results: Direct risk reduction for diabetes-related kidney disease, stroke, heart disease, and amputation were estimated for 100% compliance with diabetes treatment. Risk, case and yearly cost reduction calculated for a 100% compliance with diabetes treatment were 13.6%, 0.9 million and US$ 9.3 billion, respectively. Conclusion: Society, insurers, policy makers and other stakeholders could invest up to these amounts in screening, education and prevention efforts in an effort to reduce these costly and traumatic sequelae of noncompliant diabetes patients

TURKEY HEALTH INSURANCE PREMIUM/CLAIMS-HEALTHCARE EXPENSES IDENTIFICATION

Türkiye'de Sağlık Bakanlığı tarafından 2002 yılında Sağlıkta Dönüşüm Programı kapsamında yapılan reformların sağlık sisteminde önemli iyileştirmeler getirdiği görülmektedir. Bu değişimlerle sağlık hizmetine erişimin ve sunulan hizmetin kalitesinin artırılması hedeflenmiş, hakkaniyetli ve verimli hizmet sunumu sağlanması amaçlanmıştır. Sosyal Güvenlik Kurumu(SGK) nüfusun neredeyse tamamını kapsayan tek kamu finansmanı kuruluşudur. Kamu sağlık sigortasına ek olarak nüfusun %3`ünü kapsayan özel sağlık sigortaları da bulunmaktadır. başı toplanan prim 691 TL olurken, kişi başı sağlık harcaması ise 650 TL olmuştur. SGK' nın brüt prim-hasar/sağlık harcaması farkı bu süreçte 4,1 milyar TL'ye tekabül etmiş, oransal olarak ise %6 olmuştur.SGK tüm vatandaşlardan sağlık sigortası kapsamında topladığı primler ile sağlık sisteminde tek ödeyici kuruluştur. SGK topladığı primleri ve maliyetleri belirlerken aynı zamanda geri ödeyici kuruluş olarak ilaçlar, tıbbi cihazlar, hastane yatış maliyetleri gibi sağlık hizmet sunumunun maliyetlerini de belirlemektedir. Bu durum SGK' nın tüm nüfusu kapsayan geniş kapsamlı sağlık hizmet sunumundaki başarısını göstermektedir. Ancak SGK' nın kişi başı topladığı prim özel sağlık sigortalarının topladığı kişi başı primden düşük kalırken, kişi başı maliyet ise yüksek kalmıştır. Verimlilik noktasında oluşan soru işaretlerini gelecekte bu durumun detaylı incelenmesi gerekliliğini ortaya çıkarmaktadır.of Health in Turkey brings significant improvements. These changes targeted at improving access to health services(HS) and quality of HS. Social Security Institution(SSI) is only government payer covering of population. In addition to public health insurance(HI) there are also private HI companies(PHIC) covering 3% of population.Aim of analysis is to understand difference between premium/claims of HI system in Turkey. With this aim the official data of premiums and claims of PHIC for years 2009-2013 was obtained from Turkish PHIC Association together with same data of government HI for the same years was obtained from SSI. Descriptive analysis were conducted with premiums and claims data of government and private health insurers.TL in 2013, respectively. Difference of premium/claims of all PHC was equal to 638 million TL or 26%. Same year, premiums and claims of SSI for HI were 53 billion and 49.9 billion TL. Premiums and claims of SSI per capita were 691 TL and 650 TL in 2013, respectively. Difference of premiums/claims of SSI HI was 4.1 billion and 6%.SSI has become monopsonic payer in health system with HI premium collection from all citizens. SSI determines its revenues and costs as it also determines the premium levels and reimbursement price of HS. This shows the success of SSI`s management while covering the whole population for a very comprehensive health care package. However, the SSI`s per capita premium is lower and its claims is higher than private sector averages. Question marks that come upon the productivity issue imply that the situation should be examined thoroughly