Levels of health expenditure and payment coping mechanisms for persons living with diabetes and hypertension both singly and in comorbidity in Enugu, Southeast, Nigeria

Abstract

Context: The burden of diabetes mellitus (DM) and hypertension (HTN) both singly and in comorbidity has gained increased attention, especially in developing countries and this has great socioeconomic consequences. In Nigeria, the prevalence of both diseases is known to be increasing, while government health expenditure (HE) is not. Aim: The study examined the levels of expenditure and payment coping mechanisms for persons living with diabetes and HTN both singly and in comorbidity in Enugu, Nigeria. Methods: The study was a quantitative, cross-sectional, descriptive study done among patients attending the medical outpatient clinics. HTN and DM are the two noncommunicable diseases that were considered in this study. Data were separated into those with diabetes, HTN, or both. A descriptive analysis of sociodemographic characteristics was done. Analysis was done by estimating the direct and indirect costs. The catastrophic HE was also conducted. The mean, Chi-square, and P value were calculated in each group to assess differences in association. Results: Respondents were 817 with a mean age of 62.3 years. Respondents’ mean monthly income after food expenditure was N39465.43 ($129.0). One month earlier, 36.5%, 32.4%, and 31.1% of respondents spent more than 10% of their income on diabetes, HTN and in comorbidity, respectively, while in the current visit, 43.2%, 22.8%, and 32.0% of respondents spend more than 10% of their income on diabetes, HTN, and in comorbidity, respectively. Conclusion: The study shows that out-of-pocket is a major method of payment for diabetes and HTN. Therefore, the two diseases need to be included in the national safety net.