Key message 2: diabetes and its consequences are costly to patients and economies We estimate that, in 2015, the overall cost of diabetes in sub-Saharan Africa was US$19•45 billion or 1•2% of cumulative gross domestic product (GDP). Around $10•81 billion (55•6%) of this cost arose from direct costs, which included expenditure on diabetes treatment (eg, medication, hospital stays, and treatment of complications), with out-of-pocket expenditure likely to exceed 50% of the overall health expenditure in many countries. We estimate that the total cost will increase to between $35•33 billion (1•1% of GDP) and $59•32 billion (1•8% of GDP) by 2030. Putting in place systems to prevent, detect, and manage hyperglycaemia and its consequences is therefore warranted from a health economics perspective. Key message 3: health systems in countries in sub-Saharan Africa are unable to cope with the current burden of diabetes and its complications By use of information from WHO Service Availability Readiness Assessment surveys and World Bank Service Delivery Indicator surveys and the local knowledge of Commissioners, we found inadequacies at all levels of the health system required to provide adequate management for diabetes and its associated risk factors and sequelae. We found inadequate availability of simple equipment for diagnosis and monitoring, a lack of sufficiently knowledgable health-care providers, insufficient availability of treatments, a dearth of locally appropriate guidelines, and few disease registries. These inadequacies result in a substantial dropoff of patients along the diabetes care cascade, with many patients going undiagnosed and with those who are diagnosed not receiving the advice and drugs they need. We also noted scarce facilities to manage the microvascular and macro vascular complications of diabetes. Additionally, despite calls for adding the care of diabetes and other cardiovascular risk factors onto existing infectious disease programmes (such as those for HIV), we found little evidence that such combined programmes are successful at improving outcomes.

Objective To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care. Data Source March 2019 Health Reform Monitoring Survey. Study Design We assess the prevalence of five common patient administrative tasks—scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems—and associated administrative burden, defined as delayed and/or foregone care. Using multivariate logistic models, we examined the association of demographic characteristics with odds of doing tasks and experiencing burdens. Our outcome variables were five common types of administrative tasks as well as composite measures of any task, any delayed care, any foregone care, and any burden (combined delayed/foregone), respectively. Data Collection We developed and administered survey questions to a nationally representative sample of insured, nonelderly adults (n = 4155). Principal Findings The survey completion rate was 62%. Seventy‐three percent of respondents reported performing at least one administrative task in the past year. About one in three task‐doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01). Conclusions Patients frequently do administrative tasks that can create burdens resulting in delayed/foregone care. The prevalence of delayed/foregone care due to administrative tasks is comparable to similar estimates of cost‐related barriers to care. Demographic disparities in burden warrant further attention. Enhancing measurement of patient administrative work and associated burdens may identify opportunities for assessing quality, value, and patient experience.

Telehealth services have expanded dramatically during the coronavirus disease-2019 pandemic; we provide estimates of telehealth use and satisfaction based on a nationally representative, random survey of 3454 U.S. households. Fifty percent of households reported using telehealth because they could not receive medical care in person. Satisfaction was high among telehealth users (86%). However, satisfaction with telehealth was lower (65%) among households who reported experiences of delayed medical care for serious problems. Telehealth use was lower among rural households than urban households (46% vs. 53%) and among <$30,000 annually (47%), $30,000–<$50,000 (39%), and $75,000–<$100,000 (49%) compared with those earning $100,000 + (60%). Telehealth use was lower among households without high-speed internet compared to those with it (36 vs. 53%). Among users, satisfaction did not differ significantly by metro area, income, or internet quality. Telehealth may play a valuable role in access for many patient populations, but may not always be a perfect substitute for in-person care.