Types of the Most Frequent Provider of Ambulatory Diabetes Care and Its Impact on Continuity of Care, Medical Expenses Using National Health Insurance Database of Korea

OBJECTIVES: Several studies have noted benefits of continuity of care (COC) of most frequent provider (MFP) which the primary provider as the seen most frequently during the study period improved patient compliance, decreased health care cost. This is the large-scale observation study which confirm the types of MFP of ambulatory diabetes care and it’s the impact on continuity of care, medical expense using NHIS Database of Korea.

METHODS: This study identified the types of MFP of ambulatory Diabetes cares and categorized into three types of clinics and hospitals or higher. Moreover, this study categorized clinics into functional primary care, specialized and gray-zone clinics according to the comprehensive care provided by the clinics. Categorizing of the MFP among ambulatory diabetes care, this study investigated types of MFP of ambulatory diabetes cares and their effects on continuity of care, medical expense and health outcomes.

RESULTS: We conducted a cohort with a study population consisted of 185,911 newly diagnosed diabetes patients in 2014 from the NHIS database. The participants were then categorized into types of MFP (three types of clinics and hospitals or higher) and followed from 1 January 2015 until 31 December 2019. Compared to patients within the functional primary care clinics, those within the other types of MFP had reduced COC (specialized clinics; aOR 0.47, CI 0.45–0.49, grey-zone clinics; aOR 0.76, CI 0.73–0.80, hospitals or higher; aOR 0.89, CI 0.85–0.93). Total medical costs of patients were lowest in within the functinal primary care clinics (functional primary care; 74.2, median [IQR], specialized clinics; 156, median [IQR], grey-zone clinics; 76.5, median [IQR]).

CONCLUSIONS: Understanding the types of MFP of ambulatory diabetes care will be useful for developing healthcare programs in terms of achieving the appropriate utilization. This paper shows the results provides empirical evidence for policymakers to develop or strengthen program for regular doctor among diabetes patients.