Diabetes Care: Economic, Psychological & Nursing Impact

Introduction: Changing Dynamics in Health Care and Diabetes

The overall health care profession is undergoing fundamental change, due in part to new laws and regulations. These laws and regulations, although well intended, may result in unintended consequences for the nursing profession. In the future, the role of a nurse will be fundamentally altered. Regulation such as the Affordable Care Act will result in an entire population of newly insured patients needing care. As such, the role of a nurse will ultimately be shaped on a more individualized basis, with specialization in particular aspects of care.

Caring for patients with diabetes is no different in this regard. The public is particularly prone to diabetes primarily due to dietary and lifestyle considerations, making proper care and prevention paramount to community health. The population at risk, due in part to new regulation, is now society as a whole. This presents interesting challenges and opportunities for the health care profession, which must adjust to rapidly changing dynamics within the field.

For example, baby boomers are now reaching retirement. How will their age affect the ability to provide diabetes care that is effective from both a cost and mitigation standpoint? Younger individuals are now required to carry health insurance, yet many do not see the benefit of health care at such a young age. How will young people respond to the threat of diabetes in relation to their daily activities? How will this affect the costs of those who are already enrolled? These questions all relate to the health care profession and to diabetes care specifically. Circumstances prevailing in the industry alter not only the quality of care for diabetes, but the manner in which individuals are treated for it as well.

Economic Costs of Diabetes to Individuals and Society

One dimension of the overall diabetes problem that is rarely discussed is that of economic impact. According to the Centers for Disease Control (CDC), in 2007 the United States had almost 24 million diabetics, including nearly six million undiagnosed cases, and nearly 57 million prediabetics. Health concerns, particularly diabetes, impact society in numerous ways. Individuals are less productive when they are not properly managing their condition. In short, healthier workers are more productive — they take fewer days off and have the capacity to work longer hours, producing more for society overall.

Illness-related absenteeism, tardiness, and reduced productivity can cost society billions of dollars annually. Various studies have been conducted to measure productivity loss in the workplace due to worker illness. Results show that not only does a business suffer when a worker is absent, but productivity loss can also occur when a worker is ill yet still attempting to work. The American College of Occupational and Environmental Medicine also cites idle assets and benefits paid to absent workers as additional costs employers must bear when productivity is lost due to illness. Furthermore, the costs of hiring and training replacement workers represent a significant and often difficult-to-measure expense across broad areas of industry.

Proper treatment, diagnosis, and prevention are critical components of maintaining the general population's health. Home health care in particular is subject to significant economic constraints. Legislation such as the Affordable Care Act creates new dimensions in diabetes care and treatment, as the costs of treatment continue to increase and affect the manner in which patients receive care. In some instances, patients cannot receive care at all due to high overall cost.

Home Health Care and the Financial Burden of Diabetes

A study entitled Economic Costs of Diabetes in the U.S. in 2012, commissioned by the American Diabetes Association, addresses the increased financial burden, health resources used, and lost productivity associated with diabetes. According to the study, the total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. The study identified the largest components of medical expenditures as follows:

The economic dimension of diabetes as it relates to home health care is therefore significant. Home health care is particularly costly, creating a gap in the level of care that might otherwise be obtained within an established hospital or facility. Tertiary levels of care, which often utilize the largest amount of specialized labor, cost the most. Home health care services at the tertiary level may create financial barriers that exclude those lower on the socioeconomic ladder, further impacting the broader community as individuals who cannot afford costly home health care subsequently experience reduced productivity.

People with diagnosed diabetes incur average medical expenditures of approximately $13,700 per year, of which about $7,900 is attributed directly to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes (Stewart, 2006). Care for people with diagnosed diabetes accounts for more than one in five health care dollars spent in the U.S., and more than half of that expenditure is directly attributable to diabetes. Indirect costs identified by the study include:

Conclusion: Prevention as the Path Forward

Diabetes can be a very costly and psychologically taxing ordeal. Particularly due to its unique methods of prevention and detection, diabetes costs society and its communities roughly $250 billion a year, and these costs continue to rise at an alarming rate. Further compounding the issue are the varying stages of intervention and their high cost of implementation. At the tertiary level in particular, costs tend to reduce productivity, increase health care expenditures for society, and contribute to greater absenteeism.