Health care expenditure among hypertensive diabetics and its association with quality of care

Background: Nearly 75% of diabetics often suffer from hypertension, making this “Deadly Duet” one of the most commonly encountered diagnoses for physicians. Secondary prevention measures like Diabetes Quality Improvement Project (DQIP) and prescribing Angiotensin Converting Enzyme Inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs), have been proposed to better manage these conditions and to measure quality among hypertensive diabetics. The objective of this study was to assess the magnitude of effect that receiving quality care has on health care expenditure. Methods: Patients 18 years and older from 2007-2009 Medical Expenditure Panel Survey (MEPS) data, who were identified as both hypertensive and diabetic were included in the study. Accountability DQIP measures considered were annually performed hemoglobin A1C, feet and eye checkup. Accountability optimum care composite was defined as patients receiving all the three above mentioned DQIP measures. Use of either ACEI or ARB at least once during the year was regarded as receipt of treatment quality of care measure. A multiple linear regression was performed with log transformed total health care expenditure as the dependent variable. Total health care expenditure included costs for physician and non-physician visits, inpatient and outpatient hospital visits, emergency room visits and prescribed medicines. In addition to accountability and treatment measures model was adjusted for various predisposing, enabling and need factors using the Anderson Behavior framework. Results: Of the 100,885 individuals surveyed 3,960 patients were identified as hypertensive diabetics, representing nearly 41 million US individuals across three years. Mean age of the sample was 63 years and 52% were females. Accountability optimum care composite was only provided to one third (33.9%) of hypertensive diabetics while treatment quality of care measure was observed in 60.9%. The mean (median) health care expenditure was found to be $10,753 ($5,105). Multiple linear regression model showed that receiving optimum care composite and treatment measure increased the total health care expenditure by 24% (p-value <0.001) and 25% (p-value <0.001), respectively. Other factors affecting health care expenditure were age, medical and pharmacy insurance, general health as well as health related quality of life. Conclusions: The study reveals that quality of care received by hypertensive diabetics is inadequate especially for accountability measure. Receiving quality of care was observed to increase health care expenditure which may result into lower adherence to such preventive measures. It should be noted that the data is cross-sectional and both quality and cost are measured in the same year.