Full-Time or Working Caregiver? A Health Economics Perspective on the Supply of Care for Type 1 Diabetes Patients.

Sayaka Sakoda

doi:10.3390/ijerph19031629

Abstract

Type 1 diabetes mellitus (T1DM) is a chronic disease requiring lifelong insulin treatment. T1DM patients require care given not only by themselves but also by their family members, particularly in childhood-onset cases. This study aims to identify the relationship between health expenditure, HbA1c and other health outcomes and the socio-economic status of patients and their families, with a focus on family employment status, i.e., whether the caregiver is employed or is a homemaker. To clarify the relationship between the level of health, such as expenditure on health care and HbA1c, and the socioeconomic status of patients and their families, we focus on whether they are “potential full-time caregivers”. Using this analysis, we estimated the hypothetical health care expenditure and HbA1c and showed that male patients have higher expenditure and lower HbA1c when their caregiver is a potential full-time caregiver, whereas younger female patients have higher health care expenditure and lower HbA1c when their caregiver is employed. This finding is not meant to serve as criticism of health care policy in this area; rather, the aim is to contribute to economic policy in Japan for T1DM patients 20 years and older.

Highlights

Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by an absolute insulin deficiency resulting from the progressive immune-mediated destruction of pancreatic islet β cells
This study focused on the impact of socio-economic status (SES) on health status and vice versa, with particular attention to differences in the SES of caregivers of patients with T1DM in Japan
We estimated a hypothetical value of the impact of either health care funding or caregiver presence on blood glucose levels

Summary

Introduction

Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by an absolute insulin deficiency resulting from the progressive immune-mediated destruction of pancreatic islet β cells. T1DM depends on “luck”, which occurs through an autoimmune mechanism in young people until puberty. Management of T1DM requires many lifelong daily tasks, e.g., glucose monitoring, adherence to insulin regimen, and meal planning that the child and/or family must perform to maintain a healthy metabolism and glycaemic control [1]. The main treatment methods are multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII), and sensor-augmented pump (SAP). Except with CSII and SAP, automatic glucose measurement and self-monitoring of blood glucose must take place before insulin injections. When the patient is a child, parents will function as care coordinators, alongside health professionals and system supporters in addition to their regular parenting duties

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