Comparing Hospitalisation and Costs of Diabetes Mellitus Patients Enrolled on Disease Management Programs Versus Non-Enrolees

Abstract

Aim Type 2 diabetes mellitus (T2DM) is a chronic condition associated with poor health outcomes and high healthcare costs due to increased hospitalisations. The study aims to compare hospitalisation and costs for T2DM in medical scheme beneficiaries enrolled on a disease management program (DMP) and those not enrolled. Additionally, the factors associated with T2DM hospitalisation were identified. Methods This study adopted a quantitative and retrospective cross-sectional design using secondary hospital claims data from T2DM beneficiaries, which was primarily collected by the medical scheme. The study participants were made up of two groups of T2DM beneficiaries: those enrolled in the DMP and those who were not. Results We observed a 1.9% lower hospitalisation rate in the DMP group, with 30.58% of enrolees hospitalised compared to 32.57% of non-enrolees (p < 0.001). This reduction in hospitalisation rates was accompanied by fewer inpatient days among the 28 498 DMP enrolees compared to the 91 583 non-enrolees. Additionally, DMP enrolment was associated with cost savings of approximately ZAR R1.342 billion in hospitalisations, compared to ZAR R1.825 billion incurred by non-enrolees. The factors associated with T2DM hospitalisation were DMP enrolment, age, gender, healthcare access, geographical location, the number of chronic conditions, and insulin use. Conclusion The study demonstrates that enrolment in a DMP for T2DM beneficiaries is associated with significantly lower hospitalisation rates and shorter inpatient stays, resulting in substantial cost savings for the medical scheme. Additionally, factors such as age, gender, healthcare access, geographical location, the number of chronic conditions, and insulin use were identified as significant contributors to T2DM hospitalisation. These findings highlight the value of DMPs in improving health outcomes and reducing healthcare costs, supporting their continued investment and broader implementation within medical schemes. The evidence Page vi of 55 provided by this study advocates for the ongoing and expanded use of DMPs as a critical component of chronic disease management strategies.