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Dr.Vijay Viswanathan MD, PhD,FRCP Head & Chief Diabetologist M.V.Hospital for Diabetes &

Dr.Vijay Viswanathan MD, PhD,FRCP Head & Chief Diabetologist M.V.Hospital for Diabetes & Prof.M.Viswanathan Diabetes Research Centre Royapuram, Chennai. How do patients pay for diabetes care in India?. 2. 6.2. 11.7. 10.4. 15.2. 60. 81.2. 72. Percentage. 11.1. 28.8. `. `.

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Dr.Vijay Viswanathan MD, PhD,FRCP Head & Chief Diabetologist M.V.Hospital for Diabetes &

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  1. Dr.Vijay Viswanathan MD, PhD,FRCP Head & Chief Diabetologist M.V.Hospital for Diabetes & Prof.M.Viswanathan Diabetes Research Centre Royapuram, Chennai

  2. How do patients pay for diabetes care in India? 2 6.2 11.7 10.4 15.2 60 81.2 72 Percentage 11.1 28.8 ` ` $ 206.95 – 620.86 > $ 620.86 Tharkar et al. Diabetes Res ClinPract 2010;89:334–40

  3. IndJof Nephrology, May 2014 / Vol 24

  4. Almost 70% of the Indian population is in the below-poverty-line category, and although the cost spent on dialysis is comparatively cheaper than other countries,90% of the Indians cannot afford it. Khanna U et al,2009, Indian J Nephrol

  5. Materials and Methods • Cross sectional – Two centers between August 2008 and January 2010 ( Specialized diabetes care center, exclusively treating diabetic patients & another private hospital. • Total of 209 ( M:F=133:76) Type two Diabetic subjects. • Pretested questionnaire consisting of the details on expenditure toward the care and management of CKD and diabetes was administered by interviewing the patient.

  6. Details of direct cost per unit per patient were assessed based on

  7. Costs associated with chronic kidney disease among study groups 1USD=46.50 INR(approx)

  8. RESULTS • On an average, diabetic patients with CKD prior to ESRD spent more per hospitalization than patients without any complications. • The total median expenditure for previous two years showed significant differences between the study groups (group 1: ₹ 345,000; group 2: ₹ 500, 000; group 3: ₹ 100,000; group 4: ₹ 30,000). • The total median expenditure for hospital admissions in two years was significantly higher for patients on hemodialysisthan transplantation (P < 0.0001). • The source of funds for the expenditure in treating CKD was mainly personal savings (46%), followed by medical insurance (23%), mortgage (12.4), loan (10.0%),company reimbursement (6.2%), & sale of property ( 2.4% )

  9. DISCUSSION • The cost for a diabetic person on hemodialysis was four times highercompared to people prior to the ESRD stage. • The results of the current study reveal that the median cost involved in renal transplant was 3,92,920 INR (USD 8450). • The total medicine cost and consultation fees in treating both diabetes and CKD was significantly higher for patients on renal transplantation. • The total median expenditure for hospital admissions in two years was significantly higher for patients on dialysis than transplantation. Thus, on a long-term basis, renal transplant remains a cheaper option of treatment.

  10. DISCUSSION, contd • As the number of donor kidneys are limited, many of the patients already on dialysis require lifelong dialysis. • The huge amount which is being spent on diabetes can be brought down by preventing patients from progressing to stage III chronic kidney disease and also to end‑stage renal failure with post event cardiovascular disease. • Improvement in diabetes control has the potential to reduce direct costs involved in the treatment of complications

  11. TARGET 7 % INITIATIVE

  12. AIM Target 7% initiative programme aims to encourage and support the adoption of effective measures for control of diabetes and its complications among our patients

  13. The objective of the study is to improve the glycemic status of diabetic patients who are having poor control of blood glucose levels and bringing down their HbA1c below 7%. • Patient having • HbA1c > 9% were given Red sticker • HbA1c 7-8% were given Yellow sticker • HbA1c < 7% were given Green sticker

  14. Total no of subjects enrolled -1825 • After enrollment the patient were motivated to bring down their HbA1c by sending 2 SMS in a period of 1 month interval. • The following SMS were sent as a reminder • 1st SMS- “5 tools of diabetes management Exercise, diet, drug, monitoring & lifestyle change” • 2nd SMS- “Is your blood glucose under control, Check it now. Do regular exercise & eat healthy diet as per your diet chart”

  15. Results Baseline HbA1c

  16. Follow up results • Follow up data showed a significant reduction in the HbA1c

  17. THANK YOU

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