Diabetes Care in China: Impacts of Traditional Chinese Medicine (TCM) and Insurance on Quality and Utilization.

摘要

Today, China is facing a serious and fast growing challenge of a diabetes epidemic. With the largest diabetic population in the world, 9.7% of Chinese aged 20 and over have diabetes. However, diabetes care is far from satisfactory. The problem is further complicated by the widespread use of Traditional Chinese Medicine (TCM) and by disparities in insurance coverage. This dissertation intends to explore quality and utilization of diabetes care in China.;A multifaceted approach is adopted in this dissertation. It uses qualitative semi-structured interviews to explore the similarities and differences between TCM and conventional therapy physicians' beliefs and behaviors in outpatient care. Nonparametric propensity score matching is used to explore the effects of TCM and insurance on quality and utilization of diabetes care among hospitalized Chinese patients.;Conventional wisdom in China states that TCM is a safer and cheaper alternative of conventional therapy. The findings of this dissertation suggest the opposite. Conventional therapy physicians were reluctant to use TCM treatments in diabetes care because of safety worries. TCM was associated with higher medical costs, longer hospital stays, and no better health outcomes among hospitalized diabetes patients. These findings cast more doubts about TCM and are consistent with the questions raised by the general public and researchers in recent years.;The dissertation also finds that TCM physicians and conventional therapy physicians shared similar treatment goals. However, the two groups of physicians might have different practice styles, particularly in type 2 diabetes care. TCM physicians tended to use less aggressive treatments; while conventional therapy physicians was more likely to use aggressive insulin injections alone or in combination with oral medications. The use of non-medication interventions, including education, nutrition therapy, exercise, and psychosocial interventions, seemed to be lower than expected and inconsistent with the accepted medical guidelines. This dissertation did not find significant difference between insured patients and those without insurance on quality and utilization of care.;The findings suggest that actions are needed to increase the use of non-medication treatments in diabetes care and advance evidence-based TCM practice.