Inpatient treatment of diabetic patients in Asia: evidence from India, China, Thailand and Malaysia

Goldhaber-Fiebert, Jeremy D.; Li, H.; Ratanawijitrasin, Sauwakon; Vidyasagar, Sudha; Wang, X. Y.; Aljunid, Syed Mohamed; Shah, Nishit; Wang, Z.; Hirunrassamee, Sanita; Bairy, KL; Wang, J.; Saperi, S; Nur, Amran; Eggleston, Karen

doi:10.1111/j.1464-5491.2009.02874.x

Cited by 28 publications

(28 citation statements)

References 22 publications

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“…Other studies have found that people with DM in China and India delay seeking care for financial reasons until after they have developed more serious medical complications [29, 83]. However it is also not possible to ascertain the extent to which this may have occurred here.…”

Section: Discussionmentioning

confidence: 87%

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Gwatidzo

Williams

2017

BMC Geriatr

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BackgroundExpenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world’s two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.MethodsUsing national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents’ socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007–2010).ResultsPrevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).ConclusionsThe country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

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Section: Discussionmentioning

confidence: 87%

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Gwatidzo

Williams

2017

BMC Geriatr

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“…The predictors of higher care cost included older age, presence of complications and co-morbidities, insulin use, and care at university hospitals [33]. The average spending per admission in a tertiary care hospital in Bangkok (2005)(2006)(2007)(2008) was estimated at $1682 [34]. These numbers, however, do not reflect the bigger picture of economic loss related to diabetes care.…”

Section: Cost Of Carementioning

confidence: 97%

Diabetes in Thailand: Status and Policy

Reutrakul

Deerochanawong

2016

Curr Diab Rep

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Like other countries in the Western Pacific region, Thailand is facing increasing numbers of patients with diabetes due to unhealthy diets, high obesity rates, and an aging society. Diabetes is a considerable burden for developing countries as it reduces quality of life, increases mortality, and drives up healthcare costs. The disease detection rate in Thailand has improved in recent years, but glycemic control remains suboptimal and significant numbers of patients suffer from complications. Universal healthcare coverage has increased access to care, but inequality exists between different health plans and non-medication diabetes supplies are not yet widely covered. Diabetes self-management education has not yet been standardized and a multidisciplinary team approach is not widely utilized. The Thai government recognizes the burden of diabetes and has launched nationwide programs of health promotion and disease prevention. In addition, local initiatives have targeted reductions in specific complications, including retinopathy and diabetic foot problems, which has resulted in better disease prevention and treatment. Along with strategic public health planning, increased collaboration between private and public sectors, enhanced professional training, increased use of technology and data management, and equitable distribution of care are all needed to improve outcomes of patients with diabetes in Thailand.

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“…It is associated with impoverishment and decreased spending on food (2,3). Previous studies from developing countries suggest that individuals with diabetes often delay seeking medical care until after they have developed complications, leading to high medical spending (4–6). This suggests underutilization of preventive therapies.…”

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confidence: 99%

Diabetes, Its Treatment, and Catastrophic Medical Spending in 35 Developing Countries

2012

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OBJECTIVETo assess the individual financial impact of having diabetes in developing countries, whether diabetic individuals possess appropriate medications, and the extent to which health insurance may protect diabetic individuals by increasing medication possession or decreasing the risk of catastrophic spending.RESEARCH DESIGN AND METHODSUsing 2002–2003 World Health Survey data (n = 121,051 individuals; 35 low- and middle-income countries), we examined possession of medications to treat diabetes and estimated the relationship between out-of-pocket medical spending (2005 international dollars), catastrophic medical spending, and diabetes. We assessed whether health insurance modified these relationships.RESULTSDiabetic individuals experience differentially higher out-of-pocket medical spending, particularly among individuals with high levels of spending (excess spending of $157 per year [95% CI 130–184] at the 95th percentile), and a greater chance of incurring catastrophic medical spending (17.8 vs. 13.9%; difference 3.9% [95% CI 0.2–7.7]) compared with otherwise similar individuals without diabetes. Diabetic individuals with insurance do not have significantly lower risks of catastrophic medical spending (18.6 vs. 17.7%; difference not significant), nor were they significantly more likely to possess diabetes medications (22.8 vs. 20.6%; difference not significant) than those who were otherwise similar but without insurance. These effects were more pronounced and significant in lower-income countries.CONCLUSIONSIn low-income countries, despite insurance, diabetic individuals are more likely to experience catastrophic medical spending and often do not possess appropriate medications to treat diabetes. Research into why policies in these countries may not adequately protect people from catastrophic spending or enhance possession of critical medications is urgently needed.

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Inpatient treatment of diabetic patients in Asia: evidence from India, China, Thailand and Malaysia

Cited by 28 publications

References 22 publications

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Diabetes in Thailand: Status and Policy

Diabetes, Its Treatment, and Catastrophic Medical Spending in 35 Developing Countries

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