Economic Burden, Payment Strategies and Payment Coping Mechanism Among Type2 Diabetic Patients Attending a Tertiary Health Institution in Abia State, South East Nigeria

ABSTRACT Diabetes is a chronic life- long illness that affects the quality of life, requiring close monitoring and control. Diabetics have high risk for high economic burden (direct and indirect health costs) and catastrophic expenditure where healthcare costs are paid out of pocket. This study determined the economic burden and assessed the payment strategies and payment coping mechanisms of type 2 diabetic patients attending Out- Patient Department of Federal Medical Centre (FMC) Umuahia, Abia State, South East Zone, Nigeria, July, 2011 to June, 2012. Literature were reviewed global and in Nigeria using the Cost- of- illness (COI) framework. Five objectives guided the study and three hypotheses were tested at 0.05 level of significance using Chi-square statistics. Cross-sectional descriptive survey design was used to study a sample of 308 diabetics selected from Population of 1224 type2 Diabetic patients managed at FMC Umuahia. The instrument for data collection was the questionnaire. Reliability of the instrument determined with Cronbach alpha method which yielded a coefficient of 0.40, 0.80, 0.75 and 0.68 sections A- D respectively. Data were analysed using descriptive and inferential statistics and presented in frequencies, percentages, means and standard deviation. The major findings were direct cost of type 2 DM of ₦52,104.28 and indirect cost of ₦139,659.60. The mean monthly catastrophic type 2 diabetic costs in this study were direct cost 20.35%, indirect cost 54.55% and overall catastrophe of 37.45%. Diabetics from all socio-economic status group suffered catastrophic expenditure at 40%, 30% and 10% non-food expenditure, but the poorest socioeconomic status group had the highest incidence. At 40% threshold catastrophic expenditure by socio economic status were 44.6%, 27.4%, 17.8% and 13.9% poorest (q1) to the least poor (q4) respectively. At a variable threshold of 10% for the poorest and 30% for the least poor the catastrophic costs were 83.8% and 36.1% respectively. Private funding (Out of Pocket spending and instalment payment) were the major payment strategies used. The major payment coping mechanisms used were own money (earmarked savings and earnings), behavioural payment coping mechanisms (instalment purchase of drugs) and social support (family and friends paid). There was significant relationship between socio-economic status and catastrophic type 2 DM costs (p < 0.05). Social support (community based insurance), health insurance and prepayment, disposal of assets, community based support and cost saving/evading behaviours were significantly related to socio-economic status of the respondents. It was concluded that the economic burden of type 2 DM is high and that people living with type 2 DM pay using private funds and incur catastrophic expenditure. In order to reduce catastrophic expenditure, policies that will make services free at the point of delivery are advocated. This will reduce incidence of DM complication, morbidity and mortality from type 2 DM as well as reduce productivity losses.

TABLE OF CONTENTS

Title page i

Approval page ii

Certification iii

Dedication iv

Acknowledgement v

Table of contents vi

List of tables vii

Abstract viii

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Statement of the Problem 4

Purpose of the Study 5

Objectives of the Study 5

Research Hypothesis 5

Significance of the Study 6

Scope of the Study 7

Operational Definition of Terms 7

CHAPTER TWO: LITERATURE REVIEW

Concept of Diabetes Mellitus 9

Types of Diabetes Mellitus 10

Risk Factors/causes of Diabetes 12

Diagnosis of Diabetes Mellitus 14

Management of Diabetes 17

Concept of Catastrophic Health Expenditure 22

Catastrophic Health Expenditure in Nigeria 29

Payment Strategies in Healthcare 30

Payment Coping Mechanism 37

Conceptual Framework for the Study 41

Empirical Review 45

Summary of reviewed Literature 56

CHAPTER 3: RESEARCH METHOD

Research Design 58

Area of Study 58

Target Population 59

Sample 59

Inclusion Criteria 60

Sampling Procedure 60

Instrument for Data Collection 60

Validity of Instrument 61

Reliability of the Instrument 62

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Ethical Consideration 62

Procedure for Data Collection 62

Method of Data Analysis 63

CHAPTER FOUR: PRESENTAION OF RESULT

Summary of Findings 85

CHAPTER FIVE: DISCUSSION OF FINDINGS

Discussion of Findings 87

Conclusion 101

Implication of the Findings 102

Recommendations 102

Summary 104

Limitations of the Study 106

Suggestions for further Studies 108

References 110

Appendices 119

Appendix I- The questionnaire 120

Appendix II- Ethical clearance 128

Appendix III- Patient informed consent form 129