Impact of out of pocket health expenditure on health status among diabetese patients in the Maldives.

Abstract

Diabetes Mellitus (DM) is a one of the leading causes of mortality globally and nationally which has considerable impact on health expenditure and health status. The main purpose of this study was to identify the linkage between out of pocket expenditure and health status among DM patients in Maldives. A cross-sectional descriptive study was conducted, using 100 patients diagnosed with DM selected through systematic sampling. Interviewer-administered questionnaires were used to collect the data on socio-demographics, out of pocket expenditures, health status, comorbidities, and management of DM. Data was analyzed using excel spreadsheets, SPSS statistical software version 20 and the open source R software, version 3.1.0. This Study revealed that, OOPE is very low among Maldivian DM patients where majority of them preferred government health facilities for treatment. Health status of most of the DM patient were good whereby majority were mobile, able to self-care themselves, able to do usual activities and free from pain or discomfort and also free from anxiety or depression. Comorbidities common to Maldivians DM patients were HTN, CVD, kidney disease and Thyroid. Majority of the DM patient do not exercise or limit their diet to manage the disease. Instead majority depended on medications to manage their blood sugar. A significant relationship was found between out of pocket expenditure on travel and the ability to conduct usual activities and out of pocket expenditure on investigations and self-care level of the DM patient. Findings from this study present evidence on the need to create awareness among patients on the importance of adjusting diet, increasing exercise and limiting dependence on medicines. Preference of Maldivian DM patients to use public health facilities is an indication of affordability and trust in the public health system. However, low utilization of free health care provided by NGOs can be further researched.