Expenditure on health care incurred by diabetic subjects in a developing country - a study from southern India

The objective of the study was to estimate the direct costs of diabetes car e to patients attending secondary care facilities in Madras, India. A total of 596 subjects were studied, at the Private Hospital for Diabetes Mellitu s (PHD) (n = 422), and at the Government General Hospital (GGH) (n = 174). A simple interview schedule enabled a face to face interaction with the pat ients by the research investigator which elicited a frank and true response . The validity of the data collected was established by independent scrutin y of financial records in a sub sample. Payment bills for expenses of 140 s ubjects chosen on a random basis from the total sample of 422 PHD patients were compared with the costs reported by the subjects. There were no statis tically significant differences both in the inpatient and the outpatient ca ses between the reported cost and actual cost. Median bill value (total cos ts) = Rs.1010 (range 195-16 700) reported value = 880 (110-20 355) Z = - 0. 97, P = 0.33 and, fbr outpatients, median bill value = Rs.800 (195-4560) re ported value = Rs.740 (110-6320) Z = - 1.56, P = 0.12. For inpatients, medi an bill value = Rs.4235 (1289-16 700) reported value = Rs.5459 (1285-20 355 ), Z = - 1.27, P = 0.20. Direct cost in terms of expenditure incurred by th e patient in diabetes care and their reliance on external funding sources w ere calculated. Subjects attending the private hospital were economically b etter off than those visiting the government general hospital. In the GGH, the treatment was free of cost to the patients since the Government takes c are of the expenses involved. Hence the expenses incurred by the PHD patien ts are highlighted. Direct cost involved was high in the case of PHD patien ts. Their median expenditure was Rs.4510. (360-75200) per year. The inpatie nts spent Rs.7505 (400-75 200) and outpatients Rs.3310 (360-48 600), patien ts who underwent surgery spent Rs.13880 (550-75 200) during the study year. Those who had > 5 years duration of diabetes spent more than those who had < 5 years of duration; Rs.5570 (360-75200) and Rs.3220, (460-25 600), resp ectively. All differences between these sub-groups were statistically signi ficant. Within the ambit of economic aspects of the population in a develop ing country, the direct cost on diabetes health care is very high for many people. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.