Diabetes, Its Treatment, and Catastrophic Medical Spending in 35 Developing Countries

OBJECTIVEdTo assess the individual financial impact of having diabetes in developing countries, whether diabetic individuals possess appropriatemedications, and the extent to which health insurance may protect diabetic individuals by increasing medication possession or de-creasing the risk of catastrophic spending. RESEARCH DESIGN ANDMETHODSdUsing 2002–2003 World Health Survey data (n = 121,051 individuals; 35 low- and middle-income countries), we examined possession of medications to treat diabetes and estimated the relationship between out-of-pocket medical spending (2005 international dollars), catastrophic medical spending, and diabetes.We assessed whether health insurance modified these relationships. RESULTSdDiabetic individuals experience differentially higher out-of-pocketmedical spend-ing, particularly among individuals with high levels of spending (excess spending of $157 per year [95 % CI 130–184] at the 95th percentile), and a greater chance of incurring catastrophic medical spending (17.8 vs. 13.9%; difference 3.9 % [95 % CI 0.2–7.7]) compared with otherwise similar individuals without diabetes. Diabetic individuals with insurance do not have signifi-cantly lower risks of catastrophic medical spending (18.6 vs. 17.7%; difference not significant)