Direct Medical cost of Managing Diabetes Mellitus and Glycemic Control among Privately Insured and uninsured Patients in a Private not for Profit Facility.

Abstract

Background: Diabetes Mellitus is a significant cause of morbidity, mortality, and economic burden. This economic burden to patients can be reduced with health care insurance and as such may improve health care utilization and consequently achieve optimum glycemic level. There is however limited evidence in Uganda that compares the direct medical costs and glycemic control among patients with private health insurance and uninsured patients. Objective: To compare the direct medical costs for managing DM and glycemic control among privately insured patients and the uninsured between October 2020 to November 2021 in Mengo hospital, a private-not-for-profit health facility. Methods: This was a cross-sectional study on 500 diabetic patients who attended Mengo diabetic clinic for the period of October 2020 to November 2021 using electronically stored patient records. Data (direct medical costs, demographic and HbA1c) was extracted based on a data abstraction tool and analyzed in Stata version 14.0. A Wilcoxon rank-sum test was used to compare median direct medical costs between the insured and uninsured patients. A modified poisson regression model with robust standard error using poisson family and log link was used to examine the relationship between glycemic control and health insurance.Results: The median total medical cost of managing DM for privately insured participants was two times higher USH 1,021,550(IQR 1014675) than the median total cost among the uninsured USH 515,300(IQR 459437.5), and this difference was statistically siginificant with P-value <0.001. Having health insurance was found to increase the likelihood of having good glycemic control (PR=1.70%, 95% C.I 1.11 – 2.60, p= 0.014) Conclusion: Diabetic patients with PHI had significantly higher median direct medical cost compared to those that were uninsured attending the same health facility and having private health insurance significantly increased the likelihood of having good glycemic control. The MoH should consider all people living with NCDs irrespective of employment status as priority beneficiaries of the NHIS to improve access and utilization of services and prognosis of disease