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

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. The aim of the study was to analyze factors influencing the introduction and the use of enteral (EN) or parenteral (PN) nutrition. Material and Methods: An international survey was performed between January and December 2014 in twenty seven countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Twenty-seven (96.4%) files were returned. Results: The prevalence of malnutrition was not related to Gross National Product (GPD, p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Neither reimbursement of EN and PN use depended on GDP. The presence of reimbursement increased the use of EN and PN at hospitals (p=0.035), but not at 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: This is the first worldwide survey to explore the link between economy and the implementation of medical procedures in the field of nutrition. Results proved that reimbursement was a key factor for the effective treatment.