title: Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India.
abstract: OBJECTIVE
  This study aimed to assess the direct cost incurred by diabetic subjects who were in different income groups in urban and rural India, as well as to examine the changing trends of costs in the urban setting from 1998 to 2005.
  
  
  METHODS
  A total of 556 diabetic subjects from various urban and rural regions of seven Indian states were enrolled. A brief uniform coded questionnaire (24 items) on direct cost was used.
  
  
  RESULTS
  Annual family income was higher in urban subjects (rupees [Rs] 100,000 or $2,273) than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P < 0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Lower-income groups spent a higher proportion of their income on diabetes care (urban poor 34% and rural poor 27%). After accounting for inflation, a secular increase of 113% was observed in the total expenses between 1998 and 2005 in the urban population. The highest increase in percentage of household income devoted to diabetes care was in the lowest economic group (34% of income in 1998 vs. 24.5% in 2005) (P < 0.01). There was a significant improvement in urban subjects in medical reimbursement from 2% (1998) to 21.3% (2005).
  
  
  CONCLUSIONS
  Urban and rural diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families in developing countries is rising, and the total direct cost has doubled from 1998 to 2005.
authors.affiliation: Diabetes Research Centre, M.V. Hospital for Diabetes, WHO Collaborating Centre for Research, Education and Training in Diabetes, 4 Main Road, Royapuram, Chennai 600 013, India. ramachandran@vsnl.com
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
authors.forename: Shobhana
authors.initials: S
authors.lastname: Ramachandran
authors.forename: Chamukuttan
authors.initials: C
authors.lastname: Snehalatha
authors.forename: Christina
authors.initials: C
authors.lastname: Augustine
authors.forename: Narayanasamy
authors.initials: N
authors.lastname: Murugesan
authors.forename: Vijay
authors.initials: V
authors.lastname: Viswanathan
authors.forename: Anil
authors.initials: A
authors.lastname: Kapur
authors.forename: Rhys
authors.initials: R
authors.lastname: Williams
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003906:Developing Countries / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000191:economics*; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D007194:India; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population