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Utilization patterns of insulin for patients with type 2 diabetes from national health insurance claims data in South Korea

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  • Kyoung Lok Min
  • Heejo Koo
  • Jun Jeong Choi
  • Dae Jung Kim
  • Min Jung Chang
  • Euna Han

Abstract

Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term therapy and regular check-ups to prevent complications. In this study, insurance claim data from the National Health Insurance Service (NHIS) of Korea were used to investigate insulin use in T2DM patients according to the economic status of patients and their access to primary physicians, operationally defined as the frequently used medical care providers at the time of T2DM diagnosis. A total of 91,810 participants were included from the NHIS claims database for the period between 2002 and 2013. The utilization pattern of insulin was set as the dependent variable and classified as one of the following: non-use of antidiabetic drugs, use of oral antidiabetic drugs only, or use of insulin with or without oral antidiabetic drugs. The main independent variables of interest were level of income and access to a frequently-visited physician. Multivariate Cox proportional hazards analysis was performed. Insulin was used by 9,281 patients during the study period, while use was 2.874 times more frequent in the Medical-aid group than in the highest premium group [hazard ratio (HR): 2.874, 95% confidence interval (CI): 2.588–3.192]. Insulin was also used ~50% more often in the patients managed by a frequently-visited physician than in those managed by other healthcare professionals (HR: 1.549, 95% CI: 1.434–1.624). The lag time to starting insulin was shorter when the patients had a low income and no frequently-visited physicians. Patients with a low level of income were more likely to use insulin and to have a shorter lag time from diagnosis to starting insulin. The likelihood of insulin being used was higher when the patients had a frequently-visited physician, particularly if they also had a low level of income. Therefore, the economic statuses of patients should be considered to ensure effective management of T2DM. Utilizing frequently-visited physicians might improve the management of T2DM, particularly for patients with a low income.

Suggested Citation

  • Kyoung Lok Min & Heejo Koo & Jun Jeong Choi & Dae Jung Kim & Min Jung Chang & Euna Han, 2019. "Utilization patterns of insulin for patients with type 2 diabetes from national health insurance claims data in South Korea," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0210159
    DOI: 10.1371/journal.pone.0210159
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    References listed on IDEAS

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    1. Lasser, K.E. & Himmelstein, D.U. & Woolhandler, S., 2006. "Access to care, health status, and health disparities in the United States and Canada: Results of a Cross-National Population Based Survey," American Journal of Public Health, American Public Health Association, vol. 96(7), pages 1300-1307.
    2. Mainous III, A.G. & Koopman, R.J. & Gill, J.M. & Baker, R. & Pearson, W.S., 2004. "Relationship between Continuity of Care and Diabetes Control: Evidence from the Third National Health and Nutrition Examination Survey," American Journal of Public Health, American Public Health Association, vol. 94(1), pages 66-70.
    3. Martin Wong & Michael Leung & Caroline Tsang & S. Lo & Sian Griffiths, 2013. "The rising tide of diabetes mellitus in a Chinese population: a population-based household survey on 121,895 persons," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 269-276, April.
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    1. Kim, Woohyeon & Han, Euna, 2022. "Antibiotic prescription for acute upper respiratory tract infections: Understanding patient and physician contributions via patients’ migration," Social Science & Medicine, Elsevier, vol. 314(C).

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