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

Increasing Expenditure on Health Care Incurred by Diabetic Subjects in a Developing Country A study from India Ambady Ramachandran , MD, PHD 1 , Shobhana Ramachandran , PHD 1 , Chamukuttan Snehalatha , DSC 1 , Christina Augustine , PHD 1 , Narayanasamy Murugesan , PHD 1 , Vijay Viswanathan , MD, PHD 1 , Anil Kapur , MD 1 and Rhys Williams , MD, PHD 2 1 Diabetes Research Centre, M.V. Hospital for Diabetes, World Health Organization Collaborating Centre for Research, Education and Training in Diabetes, Royapuram, Chennai, India 2 School of Medicine, University of Wales Swansea, Swansea, U.K. Address correspondence and reprint requests to Prof. Ambady Ramachandran, MD, PhD, DSc, FRCP(Lond) (Edin), Director, Diabetes Research Centre, M.V. Hospital for Diabetes, WHO Collaborating Centre for Research, Education and Training in Diabetes, 4 Main Rd., Royapuram, Chennai 600 013, India. E-mail: ramachandran{at}vsnl.com 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 countrie