The economic burden of out-of-pocket medical expenditures for patients seeking diabetes care in Mexico

Abstract

To the Editor: Diabetes is a pressing problem for the developing countries of the Americas, where the prevalence is expected to double between 2000 and 2030 [1]. Mexico is an example of the staggering burden of diabetes; the prevalence of diabetes in this country has increased from 7.2% in 1993 [2] to 10.7% in 2000, among those who are 20–64 years of age [3]. There has been a huge increase in the number of diabetes-related deaths in Mexico over the same period, with the annual number of deaths attributed to diabetes increasing from a constant 40,000 between 1979 and 1999 to 64,000 in 2004 [4]. An original article published in 2004 presented the dimensions of the economic impact of diabetes on public health expenditures in Mexico [5]. To further evaluate the problem of the burden of diabetes in Mexico, this brief report includes the results of an analysis of private health expenditures for diabetes care, determined through out-of-pocket costs and costs paid through private medical insurance. Costs and the relative demand for different types of services required by patients with diabetes, and incidence rates for the most common long-term diabetes complications, were calculated using the methodology described in a previous article [5]. Cost data was obtained from a project that aimed to estimate the cost of chronic diseases in Mexico [6]. Service cost was estimated using an equation relating out-of-pocket expenses and private insurance to the total health expenditures in public and private institutions. This methodology has been described in detail elsewhere [5, 7]. Cost results of the 2004 National Health Survey were used as a reference, to compare the problems pertaining to equality in diabetic patients with those in the general population [8]. The different cost production functions were adjusted as a function of average diabetes case management at private institutions, determined by the consensus technique with private sector experts [8, 9]. Costs paid through private insurance were determined based on other studies reporting that for any disease there is a rate of expenditure for each particular complication [10]. We applied an equation determined by other studies [10–12] to calculate the outof-pocket user expenditures for diabetes using the following two variables: relative weight of costs to the health system and relative weight of out-of-pocket user expenditures (in absolute numbers). Table 1 shows the private health costs in two categories of analysis: direct out-of-pocket user expenditures and costs paid through private health insurance. On average, of the total expenditures in Mexico, 52% (US$162,252,503) corresponded to users’ pockets and 3% (US$9,360,714) to costs paid by private insurance, while public spending represents 45%. It is particularly important to understand this in light of the distribution of diabetes care in the public and private sectors in Mexico. Table 1 also provides the cost of care for chronic complications of diabetes for the two major service categories. Nephropathy was the complication associated with the greatest cost (75% of the total cost of complications). Diabetologia (2007) 50:2408–2409 DOI 10.1007/s00125-007-0828-4