Health insurance or subsidy has universal advantage for management of hospital malnutrition unrelated to GDP

Stanislaw Klek ； Michael Chourdakis ； Dima Abdulqudos Abosaleh ； Alejandra Amestoy ； Hyun Wook Baik ； Gertrudis Baptista ； Rocco Barazzoni ； Ryoji Fukushima ； Josef Hartono ； Ranil Jayawardena ； Rafael Jimenez Garcia ； Zeljko Krznaric ； Ibolya Nyulasi ； Gabriela Parallada ； Eliza Mei Perez Francisco ； Marina Panisic-Sekeljic ； Mario Perman ； Arina Prins ； Isabel Martinez del Rio Requejo ； Ravinder Reddy ； Pierre Singer ； Marianna Sioson ； Andrew Ukleja ； Carla Vartanian ； Nicolas Velasco Fuentes ； Dan Linetzky Waitzberg ； Steve Leonce Zoungrana ； Aleksander Galas

《Asia Pacific Journal of Clinical Nutrition》 26卷2期 (2017/03) Pp. 247-254

https://doi.org/10.6133/apjcn.122015.07

摘要

Background and Objectives: Protein-energy and micronutrient malnutrition are global public health problems which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. Methods and Study Design: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire comprised questions regarding a country's economy, reimbursement for CNS, education about and the use of EN and PN. Results: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). Conclusions: A worldwide survey by nutrition support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.

關鍵字

health insurance ； subsidy ； malnutrition ； hospital malnutrition ； nutritional management