Abstract
Background
Globally, non-communicable diseases (NCD) necessitate increased healthcare expenditure. One NCD in particular, diabetes mellitus, is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where healthcare expenditure is mostly borne out of pocket, diabetes management may pose a significant economic burden.
Methods
A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilisation and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilisation was determined by the number of visits to healthcare facilities in the last six 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.
Results
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 comorbidities, depression, stroke, auditory impairment and acid peptic disease were associated with higher healthcare utilisation. 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 to 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.
Conclusion
Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is particularly painful for patients below the poverty line and with limited insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.
Primary healthcare utilisation by older Australians during the
COVID
‐19 pandemic
