title: Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan.
abstract: BACKGROUND
  The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence.
  
  
  METHODS
  This study uses cross-sectional data collected in 2010 from Diabetes and TB patients in Bishkek, Kyrgyzstan. Quantitative questionnaires were administered to 309 individuals capturing information on patients' socioeconomic status and a range of coping strategies. Coarsened exact matching (CEM) is used to generate socio-economically balanced patient groups. Descriptive statistics and logistic regression are used for data analysis.
  
  
  RESULTS
  TB patients are much younger than Diabetes and co-affected patients. Old age affects not only the health of the patients, but also the patient's socio-economic context. TB patients are more likely to be employed and to have higher incomes while Diabetes patients are more likely to be retired. Co-affected patients, despite being in the same age group as Diabetes patients, are less likely to receive pensions but often earn income in informal arrangements. Out-of-pocket (OOP) payments are higher for Diabetes care than for TB care. Diabetes patients cope with the economic burden by using social welfare support. TB patients are most often in a position to draw on income or savings. Co-affected patients are less likely to receive social welfare support than Diabetes patients. Catastrophic health spending is more likely in Diabetes and co-affected patients than in TB patients.
  
  
  CONCLUSIONS
  This study shows that while OOP are moderate for TB affected patients, there are severe consequences for Diabetes affected patients. As a result of the underfunding of the SGBP, Diabetes and co-affected patients are challenged by OOP. Especially those who belong to lower socio-economic groups are challenged in coping with the economic burden.
authors.affiliation: Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany. arnold@bwl.lmu.de.|Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany. arnold@bwl.lmu.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Beran
authors.affiliation: Institute for Global Health, UCL, London, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli
authors.affiliation: Institute for Global Health, UCL, London, UK.
authors.forename: Neha
authors.initials: N
authors.lastname: Batura
authors.affiliation: Health Policy Analysis Centre, Bishkek, Kyrgyzstan.
authors.forename: Baktygul
authors.initials: B
authors.lastname: Akkazieva
authors.affiliation: Health Policy Analysis Centre, Bishkek, Kyrgyzstan.
authors.forename: Aida
authors.initials: A
authors.lastname: Abdraimova
authors.affiliation: Institute for Global Health, UCL, London, UK.
authors.forename: Jolene
authors.initials: J
authors.lastname: Skordis-Worrall
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D004651:Employment; D005260:Female; D005382:Financing, Personal / Q000379:methods* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007707:Kyrgyzstan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy
keywords: Burden of disease; Co-infection; Co-prevalence; Coping strategy; Cost analysis; Diabetes; Kyrgyzstan; Tuberculosis