Original Article Cost of diabetic care in India: An inequitable picture Jaya Prasad Tripathy*, B.M. Prasad International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India A R T I C L E I N F O Article history: Received 12 October 2017 Accepted 22 November 2017 Available online xxx Keywords: Non communicable disease Diabetes mellitus Out-of-pocket expenditure Catastrophic expenditure A B S T R A C T Aim: Diabetes is a growing public health problem in India which is soon going to become the ‘diabetes capital’ of the world. It requires regular care and follow up. We aimed to estimate the household out-of- pocket (OOP) expenditure and catastrophic expenditure due to hospitalization and outpatient care as a result of diabetes. Materials and methods: Secondary analysis of nationally representative data for India collected by National Sample Survey Organization in 2014, reporting on health service utilization and health care related OOP expenditure by income quintiles and by type of health facility (public or private). Results: The median household OOP expenditure from hospitalization due to diabetes was USD 151, and was 3 times higher among the richest quintile compared to the poorest quintile (p < 0.001). There was a significantly higher prevalence (p < 0.001) of catastrophic expenditure among the poorest quintile (36%) compared to the richest (14%). Median private sector OOP hospitalization expenditure was four times higher than the public sector (p < 0.001). Medicines accounted for 41% and 69% of public sector hospitalization and outpatient care respectively. Concentration indices show gross inequity in hospitalization expenditure, prevalence of catastrophic expenditure and utilization of public health facility. Conclusion: Households with diabetic patients incur a high risk of catastrophic expenditure, particularly for those in the lowest income quintiles and those seeking care in the private sector. Increased availability and access to essential drugs and strengthening of public facilities will significantly reduce OOP expenditure. © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction According to the International Diabetes Federation (IDF), around 415 million people had DM in 2015 and this number is expected to rise to 642 million by 2040 [1]. Global health care expenditures for diabetes have tripled between 2003 and 2013 as a result of an increase in the number of people with diabetes as well as the cost of health care for the treatment of diabetes. This increase is expected to grow exponentially in the coming years, especially for those with low and middle incomes [1]. In the USA, the estimated total cost of treatment for diabetes in 2012 was 245 billion USD, 176 billion USD for direct medical expenses and 69 billion USD for loss of productivity [2]. India is witnessing an alarming rise in the incidence of diabetes and soon going to become the ‘diabetes capital’ of the world. Currently home to 69.1 million people with DM, India is estimated to have the second highest number of cases of DM in the world after China in 2015 [1]. Two recent large population based studies have found the overall prevalence of DM to be ranging from 7.3– 8.3% and prediabetes from 6.3–10.3% [3,4]. DM continues to increase as a result of rapid cultural and social changes, which include: ageing populations, increasing urbanization, dietary changes, reduced physical activity and unhealthy habits coupled with strong genetic predisposition among Asian Indians [5]. India has one of the lowest public health expenditures in the world. This results in high out-of-pocket expenditure (OOP) amounting to about 70% of total health spending [6]. Financing and delivery of health care in India has been left largely to the private sector in both the urban and rural sectors catering to more than 70% of illnesses, in spite of them being very costly [7,8]. In this context of high OOP expenditure for health care and high burden of diabetes, there is little information about cost of diabetes care and its impact on households in India. * Corresponding author at: Senior Operational Research Fellow, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India. E-mail address: ijay.doc@gmail.com (J.P. Tripathy). https://doi.org/10.1016/j.dsx.2017.11.007 1871-4021/© 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved. Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2017) xxx–xxx G Model DSX 883 No. of Pages 5 Please cite this article in press as: J.P. Tripathy, B.M. Prasad, Cost of diabetic care in India: An inequitable picture, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.11.007 Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepa ge: www.elsev ier.com/locate/dsx