The Economic Burden of Diabetes Mellitus among Clients attending Health Facilities in Hawassa City, South, Ethiopia

Abstract

Background: The state of persistent hyperglycemia and associated complications of diabetes demand lifelong visits to health facilities and recurrent absenteeism from work. In a low income country like Ethiopia the economic impact of diabetes is likely to be catastrophic and appalling. Massive out of pocket expenditure and productivity loss associated with diabetes result in immense economic burden to the individual patients and their families. However, the issue is relatively unexplored in Ethiopia by policy actors as compared to communicable disease like HIV/AIDS, TB and malaria. Objective: This study tended to measure the magnitude of economic burden borne by diabetes mellitus to individual’s patient and their families attending health facilities in Hawassa city, South, Ethiopia. Methods: Facility based cross sectional study design was conducted using a consecutively selected sample of 403 diabetic clients. The study used face to face interview with diabetic clients from 5 health facilities to extract direct medical and non-medical costs and indirect cost related to diabetes. Both descriptive and inferential statistics was applied to disclose the finding of the study during data analysis. Generalized linear model (GLM) gamma with log link function and binary logistic regression at 95% confidence interval were used to assess any significant association between independent variables and dependent variable. Result: The total cost of diabetes per patient per year estimated to be birr 8,256.72 (USD 300) of which birr 6,488 (USD 235.75) is direct cost and birr 920 (USD 33.43) indirect costs. Medical cost accounted for 86.3% of direct cost and the major contributor of medical cost was made by medication cost (42.59%). The average non-medical cost is valued to be birr 1,202.29 (USD 43.68) per patient per annum. Over all monthly average direct cost is birr 733.36 (USD 26.64) per patient. About 52% of diabetic patients had catastrophic medical expenditure. Furthermore, 17.5% of non-poor households become poor (impoverished) after making catastrophic out of pocket medical expenditure. Presence of medical complication (OR:7.86;CI:2.69-22.9), longevity with diabetes (OR:1.16;CI:1.07-1.25), Household income level (3,000-6,000) (OR:3.2; CI:1.2-8.5), and type1 diabetes (OR:2.68;CI:1.3-5.3) are major associated factors for catastrophic medical expenditure. Conclusion: Diabetes mellitus is costly disease in Ethiopian healthcare system. Majority of diabetic patients were suffering from catastrophic health expenditure. In order to minimize the economic impact of the disease Federal Ministry of Health should have to design financial risk reduction mechanism through Community based health insurance (CBHI) and Social health insurance (SHI) schemes.