When we think about the cost of a medical illness, we often think just in terms of the medical bills. We may worry about how we will cover prescription costs, co-pays, and our share of the final bill. But these calculations don’t go far enough to uncover the true cost of a chronic condition.
In the case of diabetes, the total bill has to include much more than just the statements that come in the mail. Diabetes affects 30 million children and adults in the U.S. alone. Another 86 million adults are considered pre-diabetic and at risk for developing Type 2 diabetes. The cost of diabetes is higher than you might think; here’s what goes in to the final annual total of $245 billion.
Basic medical care and expenses
Basic medical care and expenses are a large part of the final total bill for diabetes care in the U.S. A person with diabetes has estimated total health care costs between two and three times more than a person without diabetes. These costs could include basics like insulin or more complicated procedures like surgeries or therapies for chronic pain associated with diabetes.
The World Health Organization estimates that in the U.S. approximately 10% of a family’s annual income goes towards basic medical care and expenses. Worldwide, direct costs for diabetes range from 2.5% to 15% of a family’s annual income.
These direct costs also include the costs that a hospital or healthcare facility might absorb, such as hospital services, physician services, lab tests, and the daily management of diabetes. These costs may include basic items like syringes for insulin injections but also include extended in-patient stays for complications that arise from diabetes or surgeries for conditions caused by diabetes.
The most expensive item on direct costs is extended stays in hospitals, most of which can be avoided by prompt diagnosis and treatment of diabetes. The single most costly procedure is lower limb amputation, many times prompted by a foot ulcer that goes undetected due to loss of lower limb sensation. The average cost for a lower limb amputation is $70,000, and in 2013, approximately 73,000 people in the U.S. required this procedure. That one procedure alone cost over $5.1 billion.
Indirect costs are harder to measure. The American Podiatric Medical Association puts the annual indirect cost of diabetes at $69 billion. This estimate may be even higher, as calculations are difficult to make accurately. The indirect cost of diabetes includes things such as:
- Missed work: Estimated to cost five billion annually
- Loss of productivity: For those both in and out of the labor force, the total annual cost is $28.5 billion
- Unable to work due to total disability: Diabetes-related disability costs approximately $21.6 billion
- Early death resulting in loss of family income: Early mortality represents an annual loss of $18.5 billion
Relying on accurate reporting of these indirect costs of diabetes may not be the best way to see the full picture. Some organizations estimate that the indirect costs are much higher than the figures above, and they don’t take into account emotional costs.
Again, it may be difficult to accurately estimate the financial cost caregivers incur. These costs include things like having to work less to care for a person with diabetes or needing to miss work due to emergency. Hidden costs may also include health conditions that a caregiver can face due to the stress of caring for a chronically ill patient.
A 2007 study of caregivers and their expenses clearly laid out the financial burden of providing long-term care to a loved one. Some of the key findings were eye-opening:
- Coming out-of-pocket: Caregivers paid an annual estimated out-of-pocket expense of over $5,500. This included expenditures for things like meals, transportation to appointments, and travel. This amount represents approximately 10% of the average caregiver’s annual income. One-third of caregivers also report dipping into their savings to help care for a loved one.
- Cutting back: Caregivers report cutting back on their spending for home maintenance (32%) and their own health care (23%) to pay for expenses related to the care of a loved one.
- Less paid work: Thirty-seven percent of those surveyed had either quit their jobs or drastically reduced their work hours to care for their family or friends.
- Emotional cost: The higher the level of out-of-pocket costs, the more a caregiver was likely to report emotional and physical effects of caregiving. The survey did not address these costs directly, but the price of counseling and the likelihood that a caregiver will develop a health issue of their own add substantially to the annual total.
Many of the survey participants reported putting off important changes in their own lives (e.g., getting married) in order to care for a loved one. The cumulative effects of these financial and emotional sacrifices can be very difficult to bear.
November is American Diabetes Month, a great time to reduce costs by practicing preventative medicine. Because the highest single direct cost associated with diabetes is lower limb amputation, American Podiatric Medical Association (APMA) President Frank Spinosa, DPM suggests starting with prevention from the ground up:
“For those who have diabetes or are at risk for the disease, regular checkups by a podiatrist are one of the easiest ways to prevent most foot complications. Including a podiatrist in your care can reduce amputation rates by as much as 85 percent. With proactive foot care, diabetes patients can reduce the risk of infection and amputation, improve function and quality of life and reduce health care costs.”
For caregivers, finding support either in-person or online can be a crucial first step to a healthier bottom line. Online resources like Dlife! can help connect caregivers to things like respite and self-care. Caregivers are possibly the most important resource a person with diabetes has, and it is important to keep them healthy – physically, emotionally, and financially.
How does the high cost of diabetes affect you and your family?