In view of the high prevalence of diabetes in Mauritius, the cost to taxpayers is high. About 40% of the population of the Republic of Mauritius is either diabetic or pre-diabetic. There has been an uptrend in total health care expenditure and yet, the prevalence of chronic non-communicable diseases (CNCD; related and preventable conditions of type II diabetes, coronary artery disease, hypertension and stroke) shows no signs of slowing. Our rates of diabetes are skyrocketing and by the year 2035, diabetes and its complications will have cost the economy over Rs 68 billion in direct costs. If the costs of productivity losses are factored in, an additional Rs 17 to 34 billion will be lost.
Fortunately, most of the complications of diabetes are preventable and the costs can be contained using modern approaches. It is worthwhile to investigate and pilot these new approaches in view of the high cost, especially if we can deliver better healthcare.
To put a human face on the issue, let us consider a couple of hypothetical scenarios. First, meet Akash. Akash is a successful 40-year old who works in corporate law in Ebène. He is married to his lovely wife Ashwini, who works part-time, so that she can raise their 3-year old son. Due to the nature of his work, Akash works long hours to meet deadlines and does not have any medical issues except for his smoker’s cough. One Monday evening, as he is finishing up an email at work, he develops severe chest pain. He is rushed to the hospital. The cardiac team diagnoses him with a heart attack, and he is also found to have high blood sugar. Akash is admitted to the cardiac unit and passes away after 3 hours.
Second, meet Fazila. Fazila is 59. She was diagnosed with diabetes at the age of 30 and has been on insulin and oral medications since then. Unfortunately, her diabetes has been hard to control, and Fazila started getting admitted to the hospital 2-3 times a year in her late forties. Fazila works in agriculture, and she frequently attends the Emergency Room due to symptoms related to her diabetes. She was recently seen by a general surgeon, who recommended an above-knee amputation due to her worsening leg ulcer. She is quite worried that her disability pension will not be enough to make ends meet after her amputation.
These heart-breaking scenarios are unfortunately all-too familiar for many of us. Akash had planned to retire at the age of 65. His untimely death not only brings great sorrow to his family but will cost the economy millions of rupees in lost productivity.
Fazila incurred myriad costs over the years due to hospital admissions, medications, clinic expenses, and surgical costs. Her most recent admission at a private hospital cost her over Rs. 75,000. According to the National Health Account (NHA) 2017 Report, diabetes cost the Mauritian taxpayer approximately Rs 1.2 billion in direct costs.
Every Mauritian knows someone like Fazila or Akash. In fact, 62% of people in Mauritius who die of cardiovascular diseases are diabetic or prediabetic.
The innovative 5-2035 Vision will not only enable high quality healthcare delivery but will also allow standardization of high-quality care, making it cheaper. High-level estimates reveal that investing in 1,500 Community Health Advanced Practitioners (CHAPs), 150 Community Health Doctors and support staff will result in cumulative savings of approximately 24 billion over the next 15 years, whereas failure to allocate more resources to this problem will end up costing the economy over Rs 70 billion.
Let us break it down. Using disease data from the NHA 2017 report, we added the diabetic burden (53%) of cardiovascular disease to the direct medical costs of diabetes (Rs 1.2 billion). Assuming indirect costs (productivity losses, disability pension etc.) of 40%, this amounts to about Rs 4.4 billion per year, out of which Rs 4.0 billion is estimated to be preventable. Note that although diabetes also plays a significant role in causing blindness, kidney disease, and foot complications, we could not factor in these costs due to inadequate data. Not only would taking these into account raise the costs significantly, but more importantly, they highlight the human cost of inaction. Our suggested 5-2035 Vision implementation will cost about Rs 1.1 billion per year. As the beneficial ripple effects are felt across the nation, the cost of diabetes will steadily decrease, plummeting down to 25% of preventable costs by the year 2035. This will result in Rs 24 billion of cumulative savings (in today’s rupees) to the Mauritian taxpayer.
For a more in-depth appreciation of those values, please refer to the spreadsheet below. You will also find the assumptions and references used in the calculations.
Had Fazila’s and Akash’s health care been supported by a grassroots integrated community health infrastructure, they would have developed neither diabetes nor its serious complications. With the 5-2035 Vision, we can become an example to the world and show that high quality health care can not only make our population healthier, but also help our economy flourish.