It is time to look how diabetes impacts people, both socially and economically.
The treatment of diabetes and its associated complications is expensive since it is a chronic condition. Not many know that the occurrence of complications can be prevented or delayed by regular check ups and good control of diabetes. Preventive care for complications may cost anywhere between Rs. 500–3000, which is largely affordable by the population, but the cost burden for not treating the complications associated with diabetes is enormous.
The socio-economic impact of diabetes is not very often discussed in medical forums. This issue is reflected in the following case study. Ramesh, a 48-year-old employee in a private firm with a monthly income of Rs.6500 and the breadwinner of a family of four, was already finding it difficult to meet his family’s routine expenses. He was suddenly diagnosed with Type 2 Diabetes and hypertension and had to spend Rs.1500 for investigations. His medications cost Rs.600 a month (direct cost). He had to pay the entire recurring medical expenses out of his own pocket because he did not have any insurance or company reimbursement.
Diabetes has reached ‘epidemic’ proportions both in developed nations as well as in the developing world. India leads the world in having the maximum number of persons with diabetes. The cost burden imposed by diabetes is not only on the patient and his family, but also on the society as a whole. Families of people with diabetes incur loss in income and productivity (indirect cost) due to frequent absenteeism from work or job loss due to diabetes. Another measure called intangible cost is beyond monetary terms, which involves the loss of employment and the cost of pain, anxiety and suffering. In India, where there is a lack of proper insurance coverage and adequate policies for diabetes treatment, most of the expenses are met as ‘out of pocket’ expenses as in the case of Ramesh. An average Indian pays his bills from his personal savings account or by mortgaging/selling his property. Many of them also take a loan with high interest rates culminating in a financial crisis. Both developed and developing countries suffer losses in billions of dollars due to diabetes.
To understand the financial costs related to diabetes and in order to plan cost effective strategies, it is important to understand the evolution of diabetes and the genesis of its complications. Many research studies have demonstrated the effectiveness of intervention programmes and changes in lifestyle in reducing the cost burden due to diabetes. Simple measures like daily and regular physical activity, maintaining optimum weight and cutting off extra calories with increased consumption of green vegetables and fruits are likely to be potentially beneficial in preventing diabetes not only among otherwise healthy people but also among those at high risk like over weight and obese people and those with impaired glucose tolerance. This is the most important and cost-effective method to reduce the huge cost burden of diabetes.
Furthermore, the cost of diabetes care is enhanced by the presence of other co-morbid conditions like hypertension. The number of hospital admission days, medical and treatment cost becomes higher when compared to those who have only diabetes. The morbidity and mortality caused by diabetes and its associated cost burden can be reduced to a large extent by what is known as secondary prevention through regular screening, early detection and appropriate treatment of its complications.
Science and technology and industrial development has led to urbanisation and increased purchasing power, thus making people more inactive and susceptible to diseases like diabetes, hypertension and other cardiovascular diseases. If the prevalence of diabetes continues to grow as suggested, the future costs would also rise considerably.
Hence awareness on prevention of diabetes is the need of the hour. Advocacy of primary prevention programmes and improved diabetes education is needed among health professionals as well as among the general population. Government and public health officials should be aware of the economic impact of this major disorder so that adequate resources can be allocated for prevention of diabetes and its complications. The people with diabetes from low income and even the middle income strata are involved in a huge debt trap leading to closed doors in all directions when they approach somebody for financial aid.
Health insurance companies can offer good schemes for people with diabetes for proper treatment and total diabetes care. Moreover there is an urgent need to create awareness on such existing insurance schemes as the knowledge of the patients on diabetes related insurance is very low. Deduction under u/s 80DDB is available for expenses on treatment of diseases and ailments specified in Rule 11D of the Income Tax rules. Now that diabetes has been identified as the leading non- communicable disease, it is time to include diabetes under section 80DDB relief. This will mitigate the cost burden on the diabetes patients to a certain extent.
When all is said and done, the bottom line is that eating less and walking more does not cost us anything.
The writers are with the M.V.Hospital for Diabetes, Royapuram, Chennai. E-mail: dr_vijay@ mvdiabetes.com