Health  Vol.9 No.8 , August 2017
An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?
Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.
Cite this paper: Nawata, K. and Kimura, M. (2017) An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?. Health, 9, 1113-1127. doi: 10.4236/health.2017.98081.

[1]   World Health Organization (2016) Global Report on Diabetes.

[2]   International Diabetes Federation (IDF) (2015) Diabetes Atlas. 7th Edition, International Diabetes Federation, Brussels.

[3]   Non Communicable Diseases Risk Factor Collaboration (2016) Worldwide Trends in Diabetes since 1980: A Pooled Analysis of 751 Population-Based Studies with 4·4 Million Participants. Lancet, 387, 1513-1530.

[4]   American Diabetes Association (ADA) (2013) Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, 36, 1033-1046.

[5]   Bommer, C., Heesemann, E.C.N., Sagalova, V., et al. (2017) The Global Economic Burden of Diabetes in Adults Aged 20-79: A Cost-of-Illness Study. Lancet Diabetes Endocrinology, 5, 423-430.

[6]   Zhang, P. and Gregg, E. (2017) Global Economic Burden of Diabetes and Its Implications. Lancet Diabetes Endocrinology, 5, 404-405.

[7]   Sohmiya, M., Yonehara, S., Sumikawa, M., et al. (2004) Tounyoubyou no Nyuuin Nissuu ni Eikyou wo Oyobosu Youin ni Kansuru Kentou (Review of the Factors Influencing the Diabetic Patients’ LOS in the Hospital). Rinsyou to Kenkyuu (The Japanese Journal of Clinical and Experimental Medicine), 81, 1031-1033.

[8]   Cook, C.B., Hentz, J.G., Miller, W.J., et al. (2007) Relationship of Diabetes with Cardiovascular Disease-Related Hospitalization Rates, Length of Stay, and Charges: Analysis by Race/Ethnicity, Age, and Sex. Ethnicity & Disease, 17, 714-720.

[9]   Kudo, T., Fujino, Y., Matsuura, A., et al. (2011) Prevalence of Type 2 Diabetes among Acute Inpatients and Its Impact on Length of Hospital Stay in Japan. Internal Medicine, 50, 405-411.

[10]   Nirantharakumar, K., Marshall, T., Kennedy, A., et al. (2012) Hypoglycaemia Is Associated with Increased Length of Stay and Mortality in People with Diabetes Who Are Hospitalized. Diabetic Medicine, 29, e445-e448.

[11]   Nirantharakumar, K., Saeed, M., Wilson, I., et al. (2013) In-Hospital Mortality and Length of Stay in Patients with Diabetes Having Foot Disease. Journal of Diabetes and Its Complications, 27, 454-458.

[12]   Nirantharakumar, K., Toulis, K.A., Wijesinghe, H., et al. (2013) Impact of Diabetes on Inpatient Mortality and Length of Stay for Elderly Patients Presenting with Fracture of the Proximal Femur. Journal of Diabetes and Its Complications, 27, 208-210.

[13]   Sharma, A., Muir, R., Johnston, R., et al. (2013) Diabetes Is Predictive of Longer Hospital Stay and Increased Rate of Complications in Spinal Surgery in the UK. Annals of the Royal College of Surgeons of England, 95, 275-279.

[14]   Centers for Disease and Prevention (2014) Average Length of Stay (LOS, in Days) of Hospital Discharges with Diabetes as First-Listed Diagnosis, United States 1988-2009.

[15]   Ncube-Zulu, T. and Danckwerts, M. (2014) Comparative Hospitalization Cost and Length of Stay between Patients with and without Diabetes in a Large Tertiary Hospital in Johannesburg, South Africa. International Journal of Diabetes in Developing Countries, 34, 156-162.

[16]   Dall, T.M., Zhang, Y., Chen, Y.J., et al. (2010) The Economic Burden of Diabetes. Health Affairs, 29, 297-303.

[17]   Minor, T. (2011) The Effect of Diabetes on Female Labor Force Decision: New Evidence from the National Health Interview Survey. Health Economics, 20, 1468-1486.

[18]   Chereches, R.M., Litan, C.M., Zlati, A.M., et al. (2012) Does Comorbid Depression Impact Diabetes Related Costs? Evidence from a Cross-Sectional Survey in a Low-Income Country. Journal of Mental Health Policy and Economics, 15, 127-138.

[19]   Condliffe, S., Link, C.R., Parasuraman, S., et al. (2013) The Effects of Hypertension and Obesity on Total Health-Care Expenditures of Diabetes Patients in the United States. Applied Economics Letters, 20, 649-652.

[20]   Minor, T. (2013) An Investigation into the Effect of Type I and Type II Diabetes Duration on Employment and Wages. Economics and Human Biology, 11, 534-544.

[21]   Sorensen, J. and Ploug, U.J. (2013) The Cost of Diabetes-Related Complications: Registry-Based Analysis of Days Absent from Work. Economic Research International, 2013, 1-8.

[22]   Alva, M., Gray, A., Mihayalov, B., et al. (2014) The Effect of Diabetes Complications on Health-Related Quality of Life: The Longitudinal Data to Address Patient Heterogeneity. Health Economics, 23, 487-500.

[23]   Lesniowska, J., Schubert, A., Wojna, M., et al. (2014) Costs of Diabetes and Its Complications in Poland. European Journal of Health Economics, 15, 653-660.

[24]   Yeaw, J. (2014) Direct Medical Costs for Complications among Children and Adults with Diabetes in the US Commercial Setting. Applied Health Economics and Health Policy, 12, 219-230.

[25]   Zhuo, X., Zhang, P., Barker, L., et al. (2014) The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention. Diabetes Care, 37, 2557-2564.

[26]   Public Health Agency of Canada (2015) The Health and Economic Impacts of Diabetes. In: Public Health Agency of Canada, Ed., Diabetes in Canada: Facts from a Public Health Perspective, Public Health Agency of Canada, Ottawa, Chapter 3.

[27]   Png, M.E., Phanm T.P. and Wee, H.L. (2016) Current and Future Economic Burden of Diabetes among Working-Age Adults in Asia: Conservative Estimates for Singapore from 2010-2050. BMC Public Health, 16, 589.

[28]   Schofield, D., Shrestha, R.N. and Cunich, M.M., et al. (2017) The Costs of Diabetes among Australians Aged 45-64 Years from 2015 to 2030: Projections of Lost Productive Life Years (PLYs), Lost Personal Income, Lost Taxation Revenue, Extra Welfare Payments and Lost Gross Domestic Product from Health & Wealth MOD 2030. BMJ Open, 7, Article ID: e013158.

[29]   Inoue, M., Iwasaki, M., Otani, T., et al. (2006) Diabetes Mellitus and the Risk of Cancer: Results from a Large-Scale Population-Based Cohort Study in Japan. Archives of International Medicine, 166, 1871-1877.

[30]   Pandey, A., Forte, V., Abdallah, M., et al. (2011) Minerva Diabetes Mellitus and the Risk of Cancer. Endocrinologica, 36, 187-209.

[31]   Ministry of Health, Labour and Welfare (2016) Kanja Shosa no Gaiyou Heisei 27 Nendo (Summary of Patents Survey in Fiscal Year 2015). Ministry of Health, Labour and Welfare, Tokyo.

[32]   Ministry of Health, Labour and Welfare (2017) The National Health and Nutrition Survey in Japan, 2015. Ministry of Health, Labour and Welfare, Tokyo.

[33]   Ministry of Health, Labour and Welfare (2016) Heisei 26 Nendo Kokumun Iryouhi no Gaikyou (Summary of National Medical Expenditures in Fiscal Year 2014). Ministry of Health, Labour and Welfare, Tokyo.

[34]   Nawata, K. and Kawabuchi, K. (2015) Evaluation of Length of Hospital Stay Joining Educational Programs for Type 2 Diabetes Mellitus Patients: Can We Control Medical Costs in Japan? Health, 7, 256-269.

[35]   Nawata, K. and Kawabuchi, K. (2015) Financial Sustainability of the Japanese Medical Payment System: Analysis of the Japanese Medical Expenditure for Educational Hospitalization of Patients with Type 2 Diabetes. Health, 7, 1007-1021.

[36]   Nawata, K. and Kawabuchi, K. (2016) Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity. Health, 8, 49-63.

[37]   Nawata, K. and Kawabuchi, K. (2016) Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of Length of Hospital Stay for Type 2 Diabetes Patients by Individual Hospital. Health, 8, 505-517.

[38]   American Diabetes Association (2014) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 37, S81-S90.

[39]   American Diabetes Association (2015) Diabetes Basic.

[40]   International Diabetes Federation (2014) About Diabetes.

[41]   Nawata, K., Ii, M., Toyama, H., et al. (2009) Evaluation of the Inclusive Payment System Based on the Diagnosis Procedure Combination with Respect to Cataract Operations in Japan. Health, 1, 93-103.

[42]   Japanese Law Translation (2009) Industrial Safety and Health Act.

[43]   Nawata, K., Matsumoto, A., Kajihara, K., et al. (2017) Evaluation of the Distribution of and Factors Affecting Blood Pressure Using Medical Checkup Data in Japan. Health, 9, 124-137.

[44]   Nawata, K. and Kimura, M. (2017) Reliability of Blood Pressure Measurements: An Analysis of the White Coat Effect and Its Fluctuations. Health, 9, 506-519.

[45]   Diaz-Valencia, P.A., Bougneres, P.P. and Valleron, A.J. (2015) Global Epidemiology of Type 1 Diabetes in Young Adults and Adults: A Systematic Review. BMC Public Health, 15, 255.

[46]   Nawata, K., Niita, A., Watanabe, S., et al. (2006) An Analysis of the Length of Stay and the Effectiveness of Treatment for Hip Fractured Patients in Japan: Evaluation of the Revision of the 2002 Medical Service Fee Schedule. Journal of Health Economics, 25, 722-739.

[47]   National Institute of Diabetes and Digestive and Kidney Diseases, US Department of Health and Human Services (2012) Health Risks of Being Overweight.

[48]   Obesity Society (2015) Your Weight and Diabetes.

[49]   American Diabetes Association (2017) Overweight.

[50]   Guidelines Subcommittee (1999) 1999 World Health Organization—International Society of Hypertension Guidelines for Management of Hypertension. Journal of Hypertension, 17, 151-183.

[51]   Cheung, B.M.Y. and Chao, L. (2012) Diabetes and Hypertension: Is There a Common Metabolic Pathway. Current Atherosclerosis Reports, 14, 160-166.

[52]   Web MD (2017) Diabetes Guide.

[53]   Center for Disease Control and Prevention (2017) Smoking and Diabetes.

[54]   Reis, J.P., Loria, C.M., Sorlie, P.D., et al. (2011) Lifestyle Factors and Risk for New-Onset Diabetes a Population-Based Cohort Study. Annals of Internal Medicine, 155, 292-299.

[55]   Adler, N.E. and Newman, K. (2002) Socioeconomic Disparities in Health: Pathways and Policies. Health Affairs, 21, 60-76.

[56]   Contoyannis, P. and Jones, A.M. (2004) Socio-Economic Status, Health and Lifestyle. Journal of Health Economics, 23, 965-995.

[57]   Cassedy, A., Drotar, D., Ittenbach, R., et al. (2013) The Impact of Socio-Economic Status on Health Related Quality of Life for Children and Adolescents with Heart Disease. Health and Quality of Life Outcomes, 11, 99.

[58]   Chen, E. and Miller, G.E. (2013) Socioeconomic Status and Health: Mediating and Moderating Factors. Annual Review of Clinical Psychology, 9, 723-749.

[59]   Stringhini, S., Carmeli, C., Jokela, M., et al. (2017) Socioeconomic Status and the 25 × 25 Risk Factors as Determinants of Premature Mortality: A Multicohort Study and Meta-Analysis of 1·7 Million Men and Women. Lancet, 389, 1229-1237.

[60]   Marliss, E.B. and Vrani, M. (2002) Intense Exercise Has Unique Effects on Both Insulin Release and Its Roles in Glucoregulation. Diabetes, 51, S271-S283.

[61]   Sigal, R.J., Kenny, G.P., Wasserman, D.H., et al. (2006) Physical Activity/Exercise and Type 2 Diabetes. Diabetes Care, 29, 1433-1438.

[62]   Colberg, S.R., Facsm, P.H.D., Sigal, R.J., Fernhall, B., et al. (2010) Exercise and Type 2 Diabetes. Diabetes Care, 33, e147-e167.

[63]   Prospective Studies Collaboration (2002) Age-Specific Relevance of Usual Blood Pressure to Vascular Mortality: A Meta-Analysis of Individual Data for One Million Adults in 61 Prospective Studies. Lancet, 360, 1903-1913.

[64]   Chew, D.S., Shaw, B.H., Isaac, D.L., et al. (2017) Orthostatic Hypotension after Continuous-Flow Left Ventricular Assist Device Implantation in a Patient with Longstanding Diabetes Mellitus. Canadian Journal of Cardiology, 33, 555.e5-555.e7.

[65]   Diabetes UK (2017) Postural Hypotension.

[66]   Diabetes UK (2017) Alcohol—Dining and Diabetes.