Economic Costs, from Individuals to Health Systems: Evidence from a Middle-Income Country

Abstract

Objective: To identify the economic burden of diabetes management in a middle-income country and its causes. Methods: Evaluative research based on a longitudinal-type design. We used the Kessner criteria and cost technology by instrumentation. For the estimation of epidemiological changes, we developed some models under the Box–Jenkins technique for the period of time 2014–2016. The financial requirements were obtained from case management costs expected by disease and the application of an econometric adjustment factor to control effects of inflation. Results: Comparing the economic impact in 2013 versus 2015 (p < 0.05), there is a 26% increase in financial requirements. The total amount for diabetes in 2015 (US dollars) was $ 8,974,662,570. It includes $ 3,981,426,810 in direct costs and $ 4993,235,752 in indirect costs. The total direct costs expected are $ 473,135,561 for the Ministry of Health (SSA), serving to uninsured population, $ 1318,506,546 for insured population (Mexican Institute for Social Security (IMSS) and Institute for Social Security and Services for State Workers (ISSSTE)), $ 2070,341,961 to users, and $ 119,442,750 to private health insurance (PHI). Conclusions: If the risk factors and the different health-care models remain as they are currently in the institutions analyzed, the financial consequences would be of major impact for the pockets of the users, following in order of importance, IMSS, SSA, and finally ISSSTE. We suggest rethinking the process of planning, organization and allocation of resources, in terms of demand for hospital and outpatients services for patients with diabetes. On the other hand, it suggests fundamental changes in the care model, increasing significantly resources and strategies toward greater prevention and primary care actions.