Increasing Expenditure on Health Care Incurred by Diabetic Subjects in a Developing Country

Abstract

OBJECTIVE— This study aimed to assess the direct cost incurred by diabetic subjects who were in different income groups in urban and rural India, as well as to examine the changing trends of costs in the urban setting from 1998 to 2005. RESEARCH DESIGN AND METHODS— A total of 556 diabetic subjects from various urban and rural regions of seven Indian states were enrolled. A brief uniform coded questionnaire (24 items) on direct cost was used. RESULTS— Annual family income was higher in urban subjects (rupees [Rs] 100,000 or $2,273) than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P < 0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Lower-income groups spent a higher proportion of their income on diabetes care (urban poor 34% and rural poor 27%). After accounting for inflation, a secular increase of 113% was observed in the total expenses between 1998 and 2005 in the urban population. The highest increase in percentage of household income devoted to diabetes care was in the lowest economic group (34% of income in 1998 vs. 24.5% in 2005) (P < 0.01). There was a significant improvement in urban subjects in medical reimbursement from 2% (1998) to 21.3% (2005). CONCLUSIONS— Urban and rural diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families in developing countries is rising, and the total direct cost has doubled from 1998 to 2005.

The economic costs of diabetes in developing countries: some concerns and recommendations

“…Moreover, the authors identified medications and devices as the most expensive component of direct costs. These results are consistent with other researchers' findings and estimates from developing countries [5,6]. Nevertheless, we are concerned that these results may underestimate the economic cost of diabetes in Iran.…”

“…Diabetes is the fourth leading cause of death by diseases worldwide; more than one million people died from diabetes in 2005 and almost 80% of these deaths occurred in low-and middle-income countries [3,4]. Due to the premature disability, morbidity and mortality associated with diabetes, diabetes is one of the most costly diseases to manage [5,6]. This burden is even more of a problem in developing countries where diabetes and associated cardiovascular diseases develop at earlier ages and with greater severity [7].…”

Healthcare-seeking behavior among diabetic patients in Kozhikode, Kerala

“…The treatment cost increases with duration of diabetes, presence of complications, hospitalization, surgery, Insulin therapy, etc. [5] Ignorance about long-term complications of apparently asymptomatic diabetes and lack of access to quality health services aggravates problem of noncompliance to treatment leading to irreversible disability and death.…”

Development at risk: addressing noncommunicable diseases at the United Nations high-level meeting

“…In India, for example, treatment for diabetes costs an affected person on average 15-25% of household earnings. 4 A World Bank study showed that cardiovascular disease leads to catastrophic expenditure for 25% of Indian families and drives 10% of families into poverty. 5 People with NCDs are also more likely to miss work, become unemployed or retire early.…”