Health expenditure patterns among rural and urban people with Diabetes Mellitus- A prospective, comparative study.

Abstract

Background: Diabetes related expenditures are increasing as advancement in treatment
strategies demand more resources to be utilized. The rise in the direct and indirect costs involved
in diabetes management has impaired the ease in adherence to treatment. Urban-rural medical
cost differences need to be taken into consideration while providing customized treatment plans.
Objectives: 1. To study the health expenditure pattern among people with diabetes. 2. To
compare the health expenditure pattern among people with diabetes living in the urban and rural
field practice areas of a tertiary care hospital at Puducherry.
Materials and Methods: A community based, prospective study was conducted among 300
individuals with type 2 diabetes in urban (n=150) and rural areas (n=150) of Puducherry selected
by cluster sampling technique. Their average expenditure on diabetes was computed for a period
of 6 months. Direct, indirect costs and catatrophic out-of pocket expenses incurred were
compared between urban and rural communities.
Results: The mean duration of diabetes was 6.72 ± 1.1 and 5.9 ± 0.96 years in the rural and
urban areas respectively. Oral hypoglycaemic drugs (93.3%) were the major treatment modality
followed by majority of patients, followed by insulin (6.7%). The monthly direct cost involved in
diabetes management was estimated as Rs. 542.17 ± 17.9 and Rs. 1516 ± 245.6 (p<0.001) and
indirect cost involved was estimated as Rs. 70.45 ± 28.1 and Rs. 242.5 ± 30.7 (p<0.001) in the
rural areas and urban areas respectively. Catastrophic expenditures were noted in 12% (n=36) of
the study participants.
Conclusion: There is an increased burden of direct and indirect costs of diabetes on the family
income. The financial burden of diabetes is more in urban compared to the rural area.
Catastrophic expenditure due to diabetes is more prevalent in urban than the rural area.