Dr. Jitendra Singh
For an average middle class person with limited sources of income and more so for the one living below poverty line, it is getting increasingly difficult to afford the cost of treatment of Diabetes and its complications particularly when the treatment is usually prolonged and often lifelong. As a result, a large number of diabetes affected individuals are constrained to be irregular in taking medication which not only lands them in incapacitating complications or disabilities but also further increases manifold the cost of managing complications that may call for expensive procedures like kidney dialysis, eye laser, foot amputation etc. The fund allocated to health sector is a very small fraction of the Govt of India’s annual budget of which much smaller fraction is earmarked for Diabetes control and prevention programmes. Very little is being discussed or planned about the enormous economic impact of Diabetes in a developing country like India which is, in next 15 years, predicted to be the home for nearly 80% of world’s total diabetic population. The cost liabilities of diabetes treatment are a burden not only for the individual suffering from this disorder but also for his family and infact the society in general. Pathetic State Sometime ago, there was this news report in the Vijaywada edition of “Indian Express’’. A diabetes affected man in the prime of his life developed a “diabetic foot’’ which eventually led to gangrene. A fruit seller by vocation, this man soon discovered that his customers, one by one,began turning away from him because of the foul smell emanating from his gangrenous foot thus resulting in a sudden decline in his daily earnings and making it difficult for him to sustain himself and his family. He approached one hosptal after the other but could not arrange the money required to carry out surgical amputation of the foot advised for him. In desperation, finally, this young son of India placed his foot on a rail track and allowed a train to run over it thus accomplishing a self-emputation of the limb. The story sums up the pathetic state of poor economic infrastructure available in this country to help an average Diabetic manage himself. As per WHO estimates, Diabetes requires a significant percent of health budget by way of cost towards direct diabetes care and diabetes related disabilities. Diabetes associated complications account for 60% of diabetes related direct health care costs and almost 80 to 90% of indirect costs. The most appalling fact is that in India, the per capita expenditure on health care is only 6.4% of the average world spending even though India accounts for 23.5% of the world’s disability adjusted life years lost due to Diabetes. According to recently published data, India presently has an annual estimated diabetes treatment cost of Rs 10,000 to 12,000 crore which is likely to witness a rise up to as much as Rs 1,26,000 crore by 2025. This figure includes direct costs incurred in treatment, laboratory tests etc, indirect costs resulting from absenteism, lowered productivity etc and cost involving management of diabetic complications by modest means. Awareness can reduce management costs From whatever data available regarding the economic cost of Diabetes, it is clear that Diabetes in future will pose a severe burden on the under-resourced health care system in India. Therefore, it is important to emphasise that public awareness about Diabetes coupled with initiative and action in early days of Diabetes can prove highly beneficial not only in terms of promising a better quality of life but also being more cost effective especially if it can prevent hospitalisation.