Abstract
In Cambodia, diabetes caused nearly 3% of the country's mortality in 2016 and became the fourth highest cause of disability in 2017. Providing sufficient financial risk protection from health care expenditures may be part of the solution towards effectively tackling the diabetes burden and motivating individuals to appropriately seek care to effectively manage their condition. In this study, we aim to estimate the distributional health and financial impacts of strategies providing financial coverage for diabetes services through the Health Equity Funds (HEF) in Cambodia. The trajectory of diabetes was represented using a Markov model to estimate the societal costs, health impacts, and individual out-of-pocket expenditures associated with six strategies of HEF coverage over a time horizon of 45 years. Input parameters for the model were compiled from published literature and publicly available household survey data. Strategies covered different combinations of types of diabetes care costs (i.e., diagnostic services, medications, and management of diabetes-related complications). Health impacts were computed as the number of disability-adjusted life-years (DALYs) averted and financial risk protection was analyzed in terms of cases of catastrophic health expenditure (CHE) averted. Model simulations demonstrated that coverage for medications would be cost-effective, accruing health benefits ($27 per DALY averted) and increases in financial risk protection ($2 per case of CHE averted) for the poorest in Cambodia. Women experienced particular gains in health and financial risk protection. Increasing the number of individuals eligible for financial coverage also improved the value of such investments. For HEF coverage, the government would pay between an estimated $28 and $58 per diabetic patient depending on the extent of coverage and services covered. Efforts to increase the availability of services and capacity of primary care facilities to support diabetes care could have far-reaching impacts on the burden of diabetes and contribute to long-term health system strengthening.
Highlights
Health and economic burden of diabetesGlobally, the prevalence of diabetes among adults rose from 5% in 1980 to 9% in 2014 and has been rapidly rising in low- and middle-income countries (LMICs) [1,2]
Given the high costs generally associated with diabetes management, we considered two different scenarios of Health Equity Funds (HEF) coverage of direct medical costs associated with diabetes-related care to illustrate the range of potential impact of HEF strategies
We modeled the benefits of providing financial coverage for diabetes care under HEF for a scenario in which they are available in the public sector
Summary
Health and economic burden of diabetesGlobally, the prevalence of diabetes among adults rose from 5% in 1980 to 9% in 2014 and has been rapidly rising in low- and middle-income countries (LMICs) [1,2]. Prevalence of diabetes among women (3.3%) has been reported to be higher than men (2.5%), and projections have estimated an 82% increase in the country’s diabetes burden from 2008 to 2028 [6,7]. Most diabetics remain undiagnosed until the onset of severe complications and medications and treatments to manage the disease are frequently only available from private providers for those who can afford it [7,8]. Management of diabetes and its related complications is generally associated with high costs [9,10]. Poverty, and economic development are closely linked, cost-effective strategies that provide sufficient financial access to essential health care will increasingly be needed
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