![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
ABSTRACT
Background: Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues.
Methods: This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012–2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office.
Results: Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively.
Conclusions: Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.
Acknowledgments
The authors are grateful to Marek Rozkrut, Ph.D., whose involvement was critical to a successful completion of this study. We also thank Prof. Ewa M. Syczewska and two anonymous Referees for useful remarks, as well as the staff of National Health Funds (NFZ) and Social Security institution (ZUS) in Poland for the provision of necessary data.
Declaration of interest
A Torój is affiliated with Warsaw School of Economics, also being a manager at consulting firm EY Poland (Economic Analysis Team). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Supplemental data
Supplemental data for this article can be accessed here.
Notes
1. also contains the frequency estimates of type 1 versus type 2 occurrence. See Section 3.7 for sources and implications of this decomposition.
2. One could in principle consider an analogous ratio for the number of work disability statements or deceases for every complication, but these are rare events and the estimation uncertainty could be incomparably higher.
3. One should differentiate between a working person and an employee (as the former involves self-employment).
4. ADA 2008, Economic Costs of Diabetes in the U.S in 2007: A synthesis of the literature found that annual health-related at-work productivity loss associated with diabetes is 9.2%, although the rate from the four studies reviewed ranged from 1.9% to 21.8% (23 items). These estimates do not simultaneously control for other factors that might be correlated with diabetes, and these same studies find that hypertension is associated with an average 6.9% decline in productivity. After adjusting the diabetes presenteeism estimate for the portion of hypertension not attributed to diabetes, we calculate a productivity loss associated with diabetes of 6.6% (or 14 days per worker with diabetes per year). The effect of lost productivity on the job due to chronic illness, such as diabetes, could be reflected in the wage of the afflicted worker rather than a cost to the employer. Our calculation of lost productivity reflects the cost to society without differentiating between the cost to the afflicted worker and the cost to the employer.
5. It should be emphasized that this survey was not conducted among the Polish population and its reference may be a source of inaccuracy if patients’ track record had highly country-specific profiles, due to e.g. different systemic approaches on the national health policy level.
6. According to the 2012 reform in the Polish pension system, the retirement age was been increased to 67 years from the previous 60 years for women and 65 years for men. However, transition-period regulations constituted a lower retirement age – between 60/65 and 67 – for the older cohorts of working age population, as a function of date of birth. Taking into account the legal framework as of 2012–2014 (years of analysis), this should be, and has been, taken into account when setting k as a function of n. The utilized values of k(n) were taken from the tables http://www.wskazniki.pl. However, one should bear in mind that the reform has been reverted in Poland in 2016 and this would somewhat reduce the indirect cost of mortality and permanent incapacity for work in the calculation related to any disease in the subsequent years.
7. Our assessment is split in the same cost categories as e.g. ADA (2008) study or Kinalska et al. (2004) ‘CODIP’ study; it also follows the general rules set forth by EY (2013). Some similar studies, however, decompose the indirect cost into three main categories: temporary disability to work, permanent disability to work, and premature death. The Reader interested in cross-study comparison may in principle add the cost of absenteeism, presenteeism, informal care, and the temporary incapacity for work to obtain the first category; treat permanent incapacity for work as the second category; and treat mortality as the third category in this classification. In such cases, we recommend to remain cautious about the precise definitions of categories used in the other studies, as they are sometimes subject to systemic limitations (see Subsection 2.1 for additional comments).