A comparison, for older people with diabetes, of health and health care utilisation in two different health systems on t
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RESEARCH ARTICLE
Open Access
A comparison, for older people with diabetes, of health and health care utilisation in two different health systems on the island of Ireland Tom Pierse1, Luke Barry1, Liam Glynn2, Andrew W. Murphy3, Sharon Cruise4 and Ciaran O’Neill4*
Abstract Background: There are social and economic differences between Northern Ireland (NI) and the Republic of Ireland (ROI). There are also differences in the health care systems in the two jurisdictions. The aims of this study are to compare health (prevalence of diabetes and related complications) and health care utilisation (general practitioner, outpatient or accident and emergency utilisation) among older people with diabetes in the NI and ROI. Methods: Large scale comparable surveys of people over 50 years of age in Northern Ireland (NICOLA, wave 1) and the Republic of Ireland (TILDA, wave 1) are used to compare people with diabetes (type I and type II) in the two jurisdictions. The combined data set comprises 1536 people with diabetes. A coarsened exact matching approach is used to compare health care utilisation among people with diabetes in NI and ROI with equivalent demographic, lifestyle and illness characteristics (age, gender, education, smoking status and self-related health, number of other chronic diseases and number of diabetic complications). Results: The overall prevalence of diabetes in the 50 to 84 years old age group is 3.4 percentage points higher in NI (11.1% in NI, 7.7% ROI, p-value < 0.01). The diabetic population in NI appear sicker – with more diabetic complications and more chronic illnesses. Comparing people with diabetes in the two jurisdictions with similar levels of illness we find that there are no statistically significant differences in GP, outpatient or A&E utilisation. Conclusion: Despite the proximity of NI and ROI there are substantial differences in the prevalence of diabetes and its related complications. Despite differences in the health services in the two jurisdictions the differences in health care utilisation for an equivalent cohort are small. Keywords: Diabetes, Complications, Health care utilisation, Quality and outcomes framework
Background Diabetic care is a substantial driver of overall health care utilisation and costs. In Europe and North America, the proportion of health care expenditure on diabetes in 2010 ranges from 6 to 14% [1]. In the Republic of Ireland, the incremental cost of additional health service * Correspondence: [email protected] 4 Centre for Public Health, Queens University Belfast, Belfast, UK Full list of author information is available at the end of the article
use is estimated to be €89 million annually [2]. Health care utilisation and health care costs among those with diabetes are strongly related to diabetic complications; in the UK, 80% of diabetic health care costs are due to complications [3, 4]. In addition to direct health care costs, diabetes significantly impacts on mortality rates, quality of life and labour market productivity [5, 6]. It is currently diffi
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