Health care delivery model in India with relevance to diabetes care

Das, Ashok Kumar; Saboo, Banshi D.; Maheswari, Anuj; Nair, Mohanan; Banerjee, Subhadeep; Jayakumar, C; V, Benny P.; P, Sunil Prasobh; Mohan, Anjana; Potty, Vasudevan Sambu; Kesavadev, Jothydev

doi:10.1016/j.heliyon.2022.e10904

Cited by 13 publications

(13 citation statements)

References 40 publications

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“…For example, in Canada, variability in how prescriptions are written and interpreted between provinces and territories can lead to delays in receiving supplies ( 35 ). In India, stigma related to social status and gender ( 41 ) and healthcare provider attitudes ( 42 ) may contribute to rationing for some individuals.…”

Section: Discussionmentioning

confidence: 99%

Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey

Souris,

Pfiester,

Thieffry

et al. 2024

Front. Clin. Diabetes Healthc.

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IntroductionContinue investigating Out-of-Pocket Expenses (OoPEs) and rationing of insulin and diabetes supplies, including impacts of the COVID-19 pandemic, for people with type 1 diabetes (T1D).MethodsA cross-sectional web-based survey was conducted in English and advertised by T1International’s global network of patient advocates from May through September 2022. Participants provided monthly OoPEs and rationing frequency for insulin and supplies, impacts of the COVID-19 pandemic, and open-ended comments.ResultsIn the seven most represented countries, mean monthly OoPEs were highest in the United States, followed by Panama, Canada, and India, and were much lower in the United Kingdom, Germany, and Sweden. OoPEs were highest for participants with partial healthcare coverage, followed by those with no healthcare coverage. The COVID-19 pandemic negatively impacted access and/or affordability of insulin and/or supplies for over half of participants. Globally, 19.5% reported insulin rationing and 36.6% reported rationing glucose testing supplies. Qualitative analysis of open-ended responses identified themes such as ‘mental health impacts’ and ‘limits to life choices.’DiscussionHigh OoPEs lead to rationing of insulin and supplies for many people with T1D globally. Healthcare systems improvements and price reductions of insulin and supplies are needed to ensure adequate, equitable access for all.

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Section: Discussionmentioning

confidence: 99%

Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey

Souris,

Pfiester,

Thieffry

et al. 2024

Front. Clin. Diabetes Healthc.

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“…Physicians from public healthcare facilities report a lack of specialised training, patient overload, poor follow-up as operational gaps in the delivery of DM care in India [84]. The low level of public health expenditure has limited the capacity and quality of healthcare services in India's public health sector [85], highlighting the necessity to increase government health spending. We found that over 60% of inpatient and outpatient care for DM was sought at private health facilities.…”

Section: Discussionmentioning

confidence: 99%

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

Nanda,

Sharma

2023

Health Care Science

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BackgroundDiabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out‐of‐pocket health expenditure (OOPE) and financial burden associated with DM care in India.MethodsThe study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.ResultsIn India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM‐affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5‐fold and 2.5‐fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.ConclusionThe burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

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“…The median (IQR) age of the MOs was 38 (35)(36)(37)(38)(39)(40)(41) years, whereas the mean (±SD) age of the ANM was 36 (±5) years. The average experience of ANMs was 8 years (±3years), compared to medical officers' median experience of 8 years (IQR: 6-9 years).…”

Section: Socio-demographic Characteristics Of the Idi Participantsmentioning

confidence: 99%

Understanding the diabetes self-care behaviour in rural areas: Perspective of patients with type 2 diabetes mellitus and healthcare professionals

Gupta,

Lakshmi,

Chakrapani

et al. 2024

PLoS ONE

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Background Diabetes self-care behaviour plays a crucial role in managing the diabetes effectively and preventing complications. Patients with type 2 diabetes mellitus (T2DM) and health care professionals (HCPs) of rural areas often face unique challenges when it comes to diabetes self-care practices (SCPs). Therefore, this study aim to explore the perspectives of patients with T2DM and HCPs on diabetes SCPs. Methods Eight focus group discussions (FGDs) among individuals with T2DM and In-depth interviews (IDIs) with 15 HCPs were conducted in rural areas of Punjab, North India. Capability, Opportunity, Motivation, and Behaviour model (COM-B) was employed for thematic framework analyses. Results The study participants perceived that a limited understanding of diabetes mellitus (DM), beliefs in alternative therapies, drug side effects, attitudes towards DM (psychological capability), comorbidities (physical capability), family support (social opportunity), financial and time constraints, and weather conditions (physical opportunity) contributed to lack of DM SCPs. Physicians’ guidance and support were motivating them to adhere to SCPs, especially when aligned with their sense of self-efficacy (reflective motivation). HCPs constraints in providing patient-centred care are due to training limitations (psychological capability) and a lack of essential resources (physical opportunities). Participants expressed need for comprehensive diabetes care (automatic motivation) through structured diabetes education intervention to improve diabetes SCPs. Conclusions The study findings indicate that various factors influence diabetes SCPs from the perspectives of both patients with T2DM and HCPs and emphasizes the need for a multi-faceted approach to improve diabetes SCPs in rural areas. Implementing a structured diabetes self-care intervention strategy in rural areas may help for preventing and mitigating the impact of diabetes-related complications in rural areas.

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Health care delivery model in India with relevance to diabetes care

Cited by 13 publications

References 40 publications

Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey

Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

Understanding the diabetes self-care behaviour in rural areas: Perspective of patients with type 2 diabetes mellitus and healthcare professionals

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