Policy Brief-Costly Disease: How to reduce out of pocket expenditure in Diabetes Care
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Diabetes prevalence in India is alarmingly rising, with over 62 million diagnosed and predictions indicating 79.4 million by 2030, burdening low-income populations significantly due to high out-of-pocket expenses for treatment. The National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke aims to combat this through improved healthcare access and affordability, yet challenges remain, particularly in rural areas where undiagnosed cases escalate costs. Recommendations include making diabetic medications affordable, enhancing organizational focus on diabetes in health coverage, and increasing community engagement for early detection and management.
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NRHM to reduce the overall morbidity and mortality due to NCDs. However as burden of
diabetes is increasing rapidly, lot to be done to reduce the out of pocket expenditure due to
diabetes. Insurance risk providers also do not cover chronic disease like diabetes into their
services.
Objective of NPCDCS
Prevent and control common NCDs through behavior and life style changes.
Provide early diagnosis and management of common NCDs.
Build capacity at various levels of health care for prevention, diagnosis and treatment of
common NCDs.
Train human resource within the public health setup via doctors, paramedics and Nursing
staff to cope with the increasing burden of NCDs, and
Establish and develop capacity for palliative & rehabilitative care.
Findings- A study based on a large dataset, found that drug costs accounted for 58% of out of-
pocket expenditure on diabetesvii
. Studies reported that the costs to hospitals and other health
providers constituted only a small part of total diabetes costs. In the study on diabetes care in
northern India, it is found that the mean cost borne by the hospital over a six-month period was
2.83% of the total direct costs. Several studies found that lower income groups generally spent a
larger proportion of their income on diabetes care that urban populations spent more in absolute
terms and that cost of complications weighed heavily on overall costs. Within the diabetes
population, low income individuals bear the highest burden of diabetesviii
.
Compromised care-
As from study by Upendra Bhojani, Arima Mishra et al 2011- there are evidences that some
patients reduced their medication dosage so that medication would last longer while one patient
reported mixing modern medication with Ayurveda remedies to reduce the overall cost. As few
patient in study told like this
“He [doctor] told me to take one tablet per day but it is costly and so I take half a tablet per day.
(Woman 52 years)”
“I take these [allopathic] medication and Ayurveda medication for two weeks alternatively to
reduce spending [on medication]. (Man 38 years)” ix](https://image.slidesharecdn.com/policybrief-anupamsingh-170126142729/85/Policy-Brief-Costly-Disease-How-to-reduce-out-of-pocket-expenditure-in-Diabetes-Care-3-320.jpg)
Policy Brief-Costly Disease: How to reduce out of pocket expenditure in Diabetes Care
- 1. 1 Anupam Singh MAD14031 Costly disease: How to reduce out of pocket expenses in diabetes care. Background - Among existing Non –Communicable Diseases (NCD), prevalence of Type 2 Diabetes Mellitus (T2DM) is become a major health concern in India. WHO has recently acknowledged that India has maximum number of diabetic patient than compared to any other country in the world. Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the diseasei . It is predicted
- 2. 2 that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in Indiaii . Since 1975, there is also a steady increase in the prevalence of diabetes mellitus in the rural dwellers in Indiaiii . Table -1 showing estimates for 2030 in millions. Source International Diabetes Federation Costly care In India, with about 25% of the population living under poverty and 41.6% of the population living under 1.25$ a day Direct medical cost to identify one subject with glucose intolerance is INR 5278iv . The cost of insulin amounts to 350.00 USD (16,000 Indian Rupees) per year, Medication for non-insulin-requiring patients costs about 70.00 USD per yearv . Out-of-pocket payments for hospital treatment for diabetes claim 17% of the annual household expenditure in poor households, a majority of whom finance the expense through borrowingvi . Government of India launched National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in 2010, which was integrated with
- 3. 3 NRHM to reduce the overall morbidity and mortality due to NCDs. However as burden of diabetes is increasing rapidly, lot to be done to reduce the out of pocket expenditure due to diabetes. Insurance risk providers also do not cover chronic disease like diabetes into their services. Objective of NPCDCS Prevent and control common NCDs through behavior and life style changes. Provide early diagnosis and management of common NCDs. Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs. Train human resource within the public health setup via doctors, paramedics and Nursing staff to cope with the increasing burden of NCDs, and Establish and develop capacity for palliative & rehabilitative care. Findings- A study based on a large dataset, found that drug costs accounted for 58% of out of- pocket expenditure on diabetesvii . Studies reported that the costs to hospitals and other health providers constituted only a small part of total diabetes costs. In the study on diabetes care in northern India, it is found that the mean cost borne by the hospital over a six-month period was 2.83% of the total direct costs. Several studies found that lower income groups generally spent a larger proportion of their income on diabetes care that urban populations spent more in absolute terms and that cost of complications weighed heavily on overall costs. Within the diabetes population, low income individuals bear the highest burden of diabetesviii . Compromised care- As from study by Upendra Bhojani, Arima Mishra et al 2011- there are evidences that some patients reduced their medication dosage so that medication would last longer while one patient reported mixing modern medication with Ayurveda remedies to reduce the overall cost. As few patient in study told like this “He [doctor] told me to take one tablet per day but it is costly and so I take half a tablet per day. (Woman 52 years)” “I take these [allopathic] medication and Ayurveda medication for two weeks alternatively to reduce spending [on medication]. (Man 38 years)” ix
- 4. 4 The financial constraints appeared to be a major barrier in accessing chronic illness medication that should be taken for years or a lifetime. Three respondents were not on medication while six respondents were not taking medication on a regular basis, as one respondent told from same study by Upendra Bhojani, Arima Mishra et al 2011. “If I have money, I will buy medicines. If I do not have money, I will just keep silent. (Man 54 years)”. This implies that diabetes is no more a disease of the rich only, it is spreading in population with lower socio-economic background also. Fig.2.Proportion of subjects using different resources used to fund care. Source-Ref-viii Policy Implication – Economic Burden of Diabetes continues to increase, especially in rural areas.
- 5. 5 In rural area diabetes remain undiagnosed due to lack of proper screening mechanism, when got diagnosed in advance stage, increases the out of pocket expenditure in larger amount due to diseases complications in advance stage. Recommendation- 1. Availability of diabetic drugs at affordable cost and sufficient stock is required like other pooled procurement of essential drugs which proved efficient. 2. As burden of disease is progressive in nature and prevalence rate is increasing in rural area also, more financing and organizational structure is required to focus on diabetes among other NCDs. More space should be provided in universal Health Coverage for diabetes detection and management. 3. Reach out to community should be maximized through mass –screening camp. This will help in early detection of the disease and can arrest disease progression, in turn reduce complications of later stage hence can mitigate catastrophic out of pocket expenditure by individuals and family. 4. Public health system should be restructured to share economic burden of disease, the way it does for RCH and other diseases , of individuals, family and care givers majority of which are dependent on private sector health system for management of diabetes, but private sector is very costly to afford, hence people lower socio-economic background cannot access the service. References : i India towards diabetes control: Key issues. Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V Australas Med J. 2013; 6(10):524-31
- 6. 6 ii IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030.Whiting DR, Guariguata L, Weil C, Shaw J Diabetes Res Clin Pract. 2011 Dec; 94(3):311-21 iii P.R.Kokiwar, Sunil Gupta, P.R.Durge. Prevalence of diabetes in a rural area of central India Int J Diab Dev Ctries, March 2007, Volume 27,Issue 1 iv Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India.Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V, Kapur A, Williams R .Diabetes Care. 2007 Feb; 30(2):252-6. v Ramachandran A. Socio-economic burden of diabetes in India. J Assoc Physicians India. 2007;55:9–12. vi Rao KD, Bhatnagar A, Murphy A. Socio-economic inequalities in the financing of cardiovascular and diabetes inpatient treatment in India. Indian J Med Res. 2011;133:57–63 vii Mahal A, Karan A, Engelgau M: The economic implications of non-communicable disease for India. Washington: World Bank; 2010. viii Shobhana R, Rao PR, Lavanya A, Vijay V, Ramachandran A: Cost burden to diabetic patients with foot complications? a study from southern India. J Assoc Physicians India 2000, 48(12):1147. viii. Rayappa PH, Raju KNM, Kapur A, Bjork S, Sylvist C, Dilip Kumar KM. Economic costs of diabetes care- The Bangalore Urban District Diabetes Study. Int J Diab Dev Countries 1999; 19 : 87-96. ix Bhojani, Upendra et al. “Constraints Faced by Urban Poor in Managing Diabetes Care: Patients’ Perspectives from South India.” Global Health Action 6 (2013): 10.3402/gha.v6i0.22258. PMC. Web. 4 Nov. 2015