A COMMUNITY BASED SURVEY OF CATASTROPHIC HEALTH EXPENDITURE IN PATIENTS WITH TYPE II DIABETES MELLITUS IN A DEVELOPING COUNTRY

Saima Nazir, MD, Ashiq Rashid Mir, MD and Arshad Rashid, MS, FNB (MAS)*

ABSTRACT

Background: To manage the epidemic of DM effectively without compromising socio-economic development, it is imperative that program managers understand the magnitude of catastrophic health expenditure (CHE). The present study was carried out to assess its frequency. Methods: The present study was carried out in the rural and urban areas of district Tumkur, Karnataka. A total of 360 participants were included in this study. Data was collected using a pre-tested questionnaire, which was administered as a face-to-face interview during house-to-house visits by the second author. Results: The mean age of the participants was 62.68 ± 8.4 years in urban areas and 59.23 ± 6.2 years in rural areas (P = 0.8634). The mean total direct cost incurred on managing diabetes was 408.12 ± 23.37 INR/month in rural areas and 516.31 ± 43.52 INR/month, while as the total indirect cost was 145.88 ± 11.42 INR/month and 155.62 ± 15.15 INR/month, respectively (P < 0.0001). A total of 97 (27%) participants experienced CHE for managing DM. The CHE was seen more frequently with urban participants [54 (30%)] as compared to subjects from rural areas [43 (24%), P < 0.0001]. CHE was seen only in those participants who underwent hospitalization. Majority of the people [126 (70%) in rural and 130 (72%) in urban areas, P = 0.7659] mobilized cash savings to meet this CHE. Conclusion: The present study points to the ever-increasing cost of diabetes care. A significant chunk of people is pushed to the brink of poverty owing to catastrophic health expenditure. There is a glaring deficit of social insurance schemes that needs to be given a boost.

Keywords: Diabetes Mellitus; Catastrophic; Expenditure; India.