Pati Sandipana, Swain Subhashisa, van den Akker Marjan, Schellevis François G, Pati Sanghamitra, Burgers Jako S
Department of Health and Family Welfare, Government of Odisha, Odisha, India.
Academic Rheumatology School of Medicine, University of Nottingham, United Kingdom.
J Family Med Prim Care. 2022 Nov;11(11):6714-6725. doi: 10.4103/jfmpc.jfmpc_1305_21. Epub 2022 Dec 16.
Globally, noncommunicable diseases (NCD) demand a higher healthcare expenditure. Among NCDs, diabetes mellitus is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where most of the healthcare expenditure is borne out of pocket, diabetes management may pose a significant financial stress.
A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilization and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilization was determined by the number of visits to healthcare facilities in the last 6 months, and out-of-pocket expenditure was assessed by outpatient consultation fees, medicines, travels to health care facilities, and diagnostic tests. Total out-of-pocket expenditure was defined as the sum of these costs.
The median number of visits in 6 months for diabetes patients with any comorbidity was 4 and 5 for diabetes patients with more than 4 comorbidities. Among the comorbid conditions, depression, stroke, auditory impairment, and acid peptic disease were associated with higher healthcare utilization. The total out-of-pocket expense was 2.3 times higher among diabetes patients with any comorbid condition compared to patients with diabetes only. The total median expenditure was higher for diabetes patients having stroke, heart diseases, kidney diseases, and cancer compared with other comorbid conditions. The association of comorbidity in diabetes patients with health care utilization and out-of-pocket expenditure is statistically significant after adjustment for sociodemographic characteristics and diabetes duration.
Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is a significant burden for diabetes patients below the poverty line and with limited or no insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.
在全球范围内，非传染性疾病需要更高的医疗保健支出。在非传染性疾病中，糖尿病常与多种并存的慢性病相关。在大多数医疗保健支出需自掏腰包的低收入和中等收入国家，糖尿病管理可能带来巨大的经济压力。
在布巴内斯瓦尔的17个城市初级医疗保健机构开展了一项横断面研究，以评估就诊于这些机构的2型糖尿病患者的医疗保健利用情况和自掏腰包支出。医疗保健利用情况通过过去6个月内就诊医疗保健机构的次数来确定，自掏腰包支出通过门诊咨询费、药品费、前往医疗保健机构的交通费和诊断检查费来评估。总自掏腰包支出定义为这些费用的总和。
患有任何合并症的糖尿病患者在6个月内的就诊中位数为4次，患有4种以上合并症的糖尿病患者为5次。在合并症中，抑郁症、中风、听力障碍和酸相关性疾病与更高的医疗保健利用率相关。患有任何合并症的糖尿病患者的总自掏腰包费用比仅患有糖尿病的患者高出2.3倍。与其他合并症相比，患有中风、心脏病、肾病和癌症的糖尿病患者的总支出中位数更高。在对社会人口学特征和糖尿病病程进行调整后，糖尿病患者合并症与医疗保健利用和自掏腰包支出之间的关联具有统计学意义。
就诊于初级医疗保健机构的糖尿病患者为管理糖尿病和其他慢性病产生了相当大的支出。这对贫困线以下且保险覆盖有限或无保险的糖尿病患者来说是一个重大负担。有必要扩大保险计划的覆盖范围，以应对门诊慢性病管理支出。
