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Health Care Costs and Financing

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Some adults with diabetes face high health care expenditures

When people with diabetes cannot afford medications or supplies (for example, syringes and blood glucose meters), they are less likely to adhere to treatment that can reduce diabetes-related complications and hospitalizations. The financial burden of care among adults with diabetes is substantial, concludes the first nationally representative study of the topic by Didem M. Bernard, Ph.D., Jessica S. Banthin, Ph.D., and William E. Encinosa, Ph.D., of the Agency for Healthcare Research and Quality. For instance, over one-fifth of nonelderly adults with diabetes who are uninsured or have public coverage spend more than half of their disposable income on health care. The financial burden is particularly heavy for women, the poor, and those with coexisting medical conditions.

Prescription medications and diabetes supplies accounted for 63 to 70 percent of out-of-pocket expenditures among nonelderly adults and 62 to 69 percent among the elderly with diabetes. Medications accounted for a larger share of out-of-pocket health care expenses among adults with diabetes (65 percent) compared with adults with heart disease (57 percent), cancer (46 percent), and hypertension (59 percent). Among the elderly with diabetes, those with private non-employment-related insurance were most likely to suffer a high financial burden followed by those insured by Medicare only, those with private employment-related coverage, and those insured by Medicaid.

Greater financial burden was linked to barriers to care and poorer treatment compliance. For example, 5.7 percent of families whose out-of-pocket health-related expenses were less than 10 percent of disposable income had a member who went without needed treatment to pay for food, shelter, and clothing. This is in contrast to 9.2 percent of families whose out-of-pocket costs exceeded 20 percent of disposable income. Redesigning drug benefit coverage to acknowledge the importance of preventive diabetes medications may reduce out-of-pocket burdens, improve treatment adherence, and prevent costly future complications, suggest the researchers. Their findings were based on analysis of 2001 data from the National Medical Expenditure Panel Survey of a representative sample of U.S. households.

See "Health care expenditure burdens among adults with diabetes in 2001," by Drs. Bernard, Banthin, and Encinosa, in the March 2006 Medical Care 44(3), pp. 210-215. Reprints (AHRQ Publication No. 06-R052) are available from the AHRQ Publication Clearinghouse.

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