Economic Burden, Payment Strategies And Payment Coping Mechanism Among Type2 Diabetic Patients Attending A Tertiary Health Institution In Abia State, South East Nigeria

ABSTRACT

Diabetes is a chronic life- long illness that affects the quality of life, requiring close

monitoring and control. Diabetics have high risk for high economic burden (direct and

indirect health costs) and catastrophic expenditure where healthcare costs are paid out of

pocket. This study determined the economic burden and assessed the payment strategies and

payment coping mechanisms of type 2 diabetic patients attending Out- Patient Department of

Federal Medical Centre (FMC) Umuahia, Abia State, South East Zone, Nigeria, July, 2011 to

June, 2012. Literature were reviewed global and in Nigeria using the Cost- of- illness (COI)

framework. Five objectives guided the study and three hypotheses were tested at 0.05 level of

significance using Chi-square statistics. Cross-sectional descriptive survey design was used to

study a sample of 308 diabetics selected from Population of 1224 type2 Diabetic patients

managed at FMC Umuahia. The instrument for data collection was the questionnaire.

Reliability of the instrument determined with Cronbach alpha method which yielded a

coefficient of 0.40, 0.80, 0.75 and 0.68 sections A- D respectively. Data were analysed using

descriptive and inferential statistics and presented in frequencies, percentages, means and

standard deviation. The major findings were direct cost of type 2 DM of ₦52,104.28 and

indirect cost of ₦139,659.60. The mean monthly catastrophic type 2 diabetic costs in this

study were direct cost 20.35%, indirect cost 54.55% and overall catastrophe of 37.45%.

Diabetics from all socio-economic status group suffered catastrophic expenditure at 40%,

30% and 10% non-food expenditure, but the poorest socioeconomic status group had the

highest incidence. At 40% threshold catastrophic expenditure by socio economic status were

44.6%, 27.4%, 17.8% and 13.9% poorest (q1) to the least poor (q4) respectively. At a

variable threshold of 10% for the poorest and 30% for the least poor the catastrophic costs

were 83.8% and 36.1% respectively. Private funding (Out of Pocket spending and instalment

payment) were the major payment strategies used. The major payment coping mechanisms

used were own money (earmarked savings and earnings), behavioural payment coping

mechanisms (instalment purchase of drugs) and social support (family and friends paid).

There was significant relationship between socio-economic status and catastrophic type 2

DM costs (p < 0.05). Social support (community based insurance), health insurance and

prepayment, disposal of assets, community based support and cost saving/evading behaviours

were significantly related to socio-economic status of the respondents. It was concluded that

the economic burden of type 2 DM is high and that people living with type 2 DM pay using

private funds and incur catastrophic expenditure. In order to reduce catastrophic expenditure,

policies that will make services free at the point of delivery are advocated. This will reduce

incidence of DM complication, morbidity and mortality from type 2 DM as well as reduce productivity losses.