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ECONOMIC LOST FROM HEALTH CARE COST OF OBESE WOMEN IN CENTRAL SULAWESI-INDONESIA
Kerugian Ekonomi Akibat Biaya Perawatan Kesehatan Pada Wanita Obesitas di Sulawesi –Indonesia
Dr. SITTI RAHMAWATI., SE., MSi
Department Faculty of Economic and Business Tadulako University Central Sulawesi-Indonesia Presentation paper "Economic Lost from Health Care Cost of Obese Women in Central Sulawesi-
Indonesia " Annual Meeting AUPHA in Monterey, California United States of America from June 18 through June 22, 2013.in Monterey Conference Center One Portola Plaza of California USA.
ABSTRACT
The increase in the prevalence of obesity among adult women in Indonesia increased in 2013 has been linked to comorbidities that affect the health care costs. The study was conducted in Central Sulawesi, in which secondary data from the 2013 Basic Health Research were analyzed. In this cross-sectional study, health care costs were calculated as direct costs that include outpatient costs and hospitalization costs. The outpatient costs in Central Sulawesi reached 219 billion rupiah, dominated by the cost of Diabetes Mellitus treatment (27,486) billion rupiah, while the total treatment cost of obese women was 1321 billion rupiah.
Keywords: Health Care Cost, Obesity, Comorbidities
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Introduction
Obesity is an important public health issue that the World Health Organization (WHO) defines as an epidemic of the 21st century. Obesity in women is associated with cancer, diabetes mellitus, hypertension, heart disease, stroke, and comorbidities. The increasing prevalence of obesity affects leads to higher health care costs. The economic analysis related to obesity was conducted using two approaches; the step-down method approach to measure the proportion of comorbidities in obese women and the bottom-up method using a longitudinal and cross-sectional set of data. In this study, the top-down method was used in order to examine the amount of cost in the treatment of comorbidities being studied.
The global prevalence of overweight (overweight and obesity) between 1980 and 2013 was 37.5% in adults. The nutrition-related issue in Southeast Asia reached 22.3%, with obesity prevalence among adult men of 4.8% and 7.6% in adult women. Nearly 60% of the adult population will be obese by 2030 as a result of the projected global prevalence of obesity in 2005 (Lehnertn 2013).
The results of a study done by J.H. Kang et al, 2011, the cost of health care due to obesity in adults in a systematic review done in some countries made up to 0.7%-2.8% of the total national health care expenditure in Indonesia. In obese adults in Korea, the cost incurred on female subjects (US$ 584 Million) is higher than male subjects (US$ 497 million). The average health care costs incurred in Thailand due to obesity (5584 million ) were equivalent to national health expenditures in Thailand.
The amount of health care costs is not proportional to the available health resources. For this reason, it is important to estimate the health care costs due to obesity in order to make the scale of priority upon the available resources to be allocated greater for regions with a bigger economic burden due to large health care costs. This study calculated the economic loss due to the health care cost of obese women in Sulawesi, Indonesia.
Materials and Method
This study used a cross-sectional study design to calculate costs due to obesity treatment. This study regarded secondary data from the results of the 2013 Basic Health Research in Sulawesi. The units of analysis in this study were obese women in Sulawesi, Indonesia. The secondary data included sample characteristics of weight, and height, obesity prevalence, health care costs (inpatient and outpatient), number of obese female patients associated with the "Relative Risk" (RR) comorbidity. Estimating the costs associated with obesity, then the number of people with comorbidities (cancer, diabetes mellitus, hypertension, heart disease, and stroke). identified the cost of each commodity (Basic Health Research Results, 2013). The following formula was used to calculate the proportion of comorbidities in a population of obese women (Population Attributable Fraction) = PAF): The following formula was employed to calculate the proportion of comorbidities in obese women or Population Attributable fraction (PAF).
Population Attributable Fraction (PAF) =……Pr (RR-1)
…………
Pr (RR-1
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Description:
PAF = Proportion of comorbid events in the obese population (%) Pr = Prevalence of obesity (%)
RR = Relative Risk Comorbidity
Health care costs for obesity with six comorbidities (cancer, diabetes mellitus, hypertension, ischemic heart, osteoarthritis, and stroke) are divided into two, namely outpatient and inpatient services. For each comorbidity, the cost of health care during inpatient and outpatient is calculated by multiplying the proportion of the incidence of comorbidities in the obese female population with the average costs incurred and the total population. Each comorbid total is summed to obtain the total cost for health care for obesity as well as the average outpatient and inpatient costs for each comorbidity (person/year) were obtained from the results of the 2013 Basic Health Research. Health care costs are incurred as compensation for health services received at the Health Service Center (government or private hospitals, health centers, and doctors). Health care costs during inpatient and outpatient are direct costs that include compensation for health services, health facilities, and medicine to prevent and treat obesity and associated comorbidities. According to D Withrow (2011), health care costs during inpatient and outpatient are distinguished by the gender of obese women. The following formula is to calculate the health care costs incurred due to obesity in women for each comorbidity:
Health Care Cost Outpatient (HCCo) = PAF X AC X N Health Care Cost Inpatient (HCC I) = PAF X AC X N
Health Care Cost (HCC) = HCCo =HCCi
Description:
HCC = Treatment costs due to obesity (Rupiah/year)
HCCo = Health Care Costs for obese female outpatients with comorbidities (Rupiah/year) HCCi = Health Care Costs for obese female inpatients with comorbidities (Rupiah/year) N = Total population aged 18 – 64 years (person)
PAF = Proportion of comorbid events in the obese population (%)
AC = Average Cost incurred for each comorbidity per person per year (Rp/person/year).
Findings
This study indicates that diabetes mellitus is a comorbid disease with the largest health care costs compared to other diseases. This is presumably due to the large number of medical actions taken for diabetic patients (expensive drugs, routine laboratory checks, and surgery are unavoidable in the event of a wound that causes infection). If the current trend of population weight continues to increase, it might lead to weight gain in the long term. Park et al (2006) state that the increased risk of disease will spread more widely because there is exposure to risk factors. To be able to prevent and reduce diseases
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caused by obesity, it is necessary to have health interventions that can affect the shift in the overall distribution of risk factors that are effective from focusing on groups at high risk for the impact caused by obesity. For example, WHO recommends policies to control the price of high-calorie foods to reduce the burden of disease caused by obesity.
The estimated cost incurred by obesity in Indonesia, especially eastern Sulawesi is a very high economic cost. However, it affects the company through the loss of production-related productivity.
Furthermore, the most affected by obesity are individuals through the loss of pocket money that should be used to meet biological needs but is used for health care costs and society as a whole through the total cost of living for the population with reduced optimal health instead. According to Coldman Hayward (2010), if only part of the cost of disease caused by obesity could be reduced, the result could be reduced spending on disease care and healthier populations. Handling obesity must be a priority, including at the age of children because obesity tends to occur in adulthood accompanied by comorbidities. For this reason, a policy is needed in an effort to reduce the prevalence of obesity as a form of attention to the decline in the health status of the population.
Table 1 presents the results obtained that three cases of the disease with the largest proportion of comorbidities.
Table 1.
Province PROPORTION OF COMORBIDITY EVENTS (%) IN WOMEN SULAWESI 1 2 3 4 5 6 Total (%)
North Sulawesi Utara 2.7 48.6 9.8 27.6 10.4 2.6 16.95
Central Sulawesi 2.0 37.7 7.3 20.9 7.9 1.9 12.95
South Sulawesi 1.8 32.3 6.4 18.6 7.1 1.7 11.26
Southeast Sulawesi 2.5 45.5 9.1 25.8 9.8 2.4 15.85
West Sulawesi 1.5 27.3 5.4 15.8 6.0 1.5 9.56
Average Score 2.10 38.28 7.60 16.22 6.0 1.40 11.10 Description : 1 = Cancer; 2 = Diabetes Mellitus; 3= Hypertension; 4 = Ischemic Heart;
5 = Osteoarthritis ; 6 = Strokes.
Secondary Data Source: 2013 Basic Health Survey
Table 1 presents the results obtained that the three cases of disease with the largest proportion of comorbidities caused by obese women in the Sulawesi, Indonesia, were diabetes mellitus (27.3%- 48.6%), ischemic heart (15.8%-27.6%), hypertension (5.4%-9.8%), osteoporosis (6.0-10.4%). The estimated proportion of comorbidities of 27.3 % - 48.6% related to diabetes mellitus was caused by
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obesity. The average proportion of comorbidities in the obese female population in Sulawesi (12.57%) was higher than that of male subjects in Indonesia (5.8%). According to R Colman et al (2010), the high proportion of comorbid events in the obese population causes the need for health services to deal with the severity of these comorbidities. This causes a high level of visits to health care facilities to increase the costs incurred for health care. The total average estimated cost of health care in Sulawesi, eastern Indonesia, for the six comorbidities studied was 1,321 billion rupiah/year.
Diabetes is a comorbidity that has the largest health care costs caused by obesity in female subjects of 2,342 billion rupiah per year.
The high proportion of comorbid events in the obese population in the eastern part of Indonesia, Sulawesi, can affect the quality of life and the health status of the population related to cases of diseases caused by obesity. In this study, secondary data from 2013 showed that obese females in Sulawesi have a higher proportion of events (12.57%) than men in Indonesia (5.8%). This is associated with an increase in fat storage and slower metabolism in women than men. This also occurs in South Sulawesi Province which has the highest average estimated proportion of comorbid events. The high and low proportion of comorbid events in the obese population is thought to be due to the high prevalence of obesity influenced by the proportion of consumption behavior of vegetables and fruit, as well as the proportion of risky food behavior, such as sweet, salty, fatty foods, and grilled baked goods.
One of the top four Provinces that has a proportion of less eating fruits and vegetables from 2007 to 2013 is North Sulawesi Province. Moreover, the proportion of fatty foods consumed is almost 50% of the population of North Sulawesi Province. With the increasing proportion of causes of obesity from the nutritional aspect, it might affect the incidence of comorbidities. Comorbidity has implications for increased mortality and morbidity rates, thus affecting the health care costs incurred to treat these comorbidities. Based on the data in Table 2 below, the largest expenditure on health care costs incurred by women is in the South Sulawesi Province with a total expenditure of IDR 2,262 billion/year. Meanwhile, the lowest expenditure on health care costs is in Central Sulawesi Province with IDR 349 billion/year. The proportion of morbidity in Diabetes Mellitus is higher than in other co- morbidities. This is presumably due to the large number of medical actions performed on people with diabetes mellitus and other diseases. This might be due to the large number of medical actions taken
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for people with diabetes mellitus and cardiovascular disease that reducing body weight by 5-10% can improve blood sugar control and help reduce cardiovascular risk.
Table 2. Estimated Cost of Treatment for Obese Women (Billion/Rupiah/Year) conversion of IDR 14,500/US$ (Billion)
Province 1 2 3 4 5 6 Total US$
North Sulawesi 1 394
(US$ ) 101 189 57 33 768
Central Sulawesi 0 130 35 81 94 9 349
South Sulawesi 0 1548 113 464 123 14 2262
Southeast Sulawesi 0 269 28 155 68 9 530
West Sulawesi 1 1 3 0 10 1 90
Average 2 2342 280 889 346 66 3999
Sulawesi Total
Health Cost 7924/6
1321 Billion Source: 2013 Basic Health Research (Secondary Data)
Description: 1 = Cancer, 2= Diabetes Mellitus,3=Hypertension,4=Ischemic Heart,5=Osteoarthritis 6= Strokes
T Lehnert et al (2013) argue that the incidence of disease risk will spread more widely because there is exposure to risk factors. To be able to prevent and reduce the burden of disease caused by obesity, health interventions are needed to influence the shift in the overall distribution of risk factors rather than focus groups at high risk for the impacts caused by obesity. For example, WHO (2013) recommends policies to control the price of high-calorie foods to reduce the burden of disease caused by obesity. The estimated cost of obesity in Sulawesi is a significant economic cost and not only for the health care system. However, this affects the company through the loss of production-related work productivity. Furthermore, the main target who most feels the impact of obesity is the group of women who become the burden of development through the loss of pocket money that should be used to meet biological needs but is used for health care. Handling obesity should be a priority including at the age of children because obesity tends to occur in adulthood accompanied by comorbidities. For this
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reason, a policy is needed to reduce the prevalence of obesity as a form of attention to the decline in the health status of the population.
CONCLUSIONS AND SUGGESTIONS
The cost of treating obesity for female subjects is higher than male obesity in Indonesia (average 1,548 billion rupiah (US$ billion/year). The comorbidity with the highest cost is Diabetes Mellitus with a total cost of 1,548 billion rupiah/year in South Sulawesi, while in North Sulawesi it only costs 394 billion Rupiah/year for Diabetes Mellitus. Furthermore, the second rank in South Sulawesi is ischemic heart disease with a total cost of 464 billion rupiah/year. Regional comorbidities with low disease treatment costs in the West Sulawesi area with an average treatment cost for diabetes of 1 billion Rupiah/year. The total cost of care for the Sulawesi Region for comorbid obesity in female subjects is an average of 1,321 billion Rupiah. The results of this study indicate that the cost of health care due to obesity and major colic disease can cause an economic burden for individuals and countries. Thus, prevention and repetition in the form of promotive policies and facilities that support changes in lifestyle and physical activity towards a healthy life are needed.
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REFERENCES
Agency of Health Research and Development. Hasil Riset Kesehatan Dasar. Jakarta: Indonesian Ministry of Health, 2013
Colman R, Hayward K. The Cost of Obesity in Alberta, Canada: Atlantic Canada Incorporated 2010.
Lehnert T. Sonntag D, Konnopka A, Riedel -Heller S,Konig H. Economic Cost of Overweight and Obesity , Elsiever 2013;27;105:115
Park J-H, Yoon-S-J, Lee S-I Kim Y, Kim, Shin y. Burden of diseases Attributable to Obesity and Overweight in Korea. International Journal of Obesity 2006:30:1661-1669
Kang JH, Jeong BG, Cho YG, Song HR, Kim KA, Socioeconomic Costs of Overweight and Obesity in Korea Adults, Journal Korean Medicine Science, 2011;26: 1533-1540
Withrow D. Alter DA. The Economic Burden of Obesity Worldwide: a Systematic Review of Direct Costs of Obesity: Journal of Obesity 2011;12: 131-141
World Health Organization.Obesity and Overweight, Geneva: WHO Multicenter Growth Reverence Study Group;2013.
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KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI UNIVERSITAS TADULAKO
Kampus Bumi Tadulako Tondo Palu - Sulawesi Tengah 94111 JI. Soekarno Hatta Km. 9 Telp : (0451) 422611 – 422355 Fax: (0451)
422844
email: untad@untad.ac.id SURAT IZIN
Nomor: 4896/UN.28/KP/2010
Yang bertanda tangan dibawah ini :
Nama : Prof Dr.Ir Muhammad Basir , SE.,M.Si
NIP : 19610202 198903 1 001
Jabatan : Rektor Universitas Tadulako Dengan ini memberikan izin kepada :
Nama : Dr.Sitti Rahmawati,SE.,M.Si
NIP : 196209131990012001
Pangkat/Gol : Pembina Tkt I , IV/b
Unit Kerja : Fakultas Ekonomi Universitas Tadulako
Untuk mengikuti dan menjadi pembicara pada konferensi International (as presenter) Oral Presentation dengan judul “ “ Economic Lost From Health Care Cost of Obese Women in Central Sulawesi Indonesia” pada tanggal 18-22 June in Monterey Conference Center One Portola Plaza California, United Stated of America.(USA) .Tahun 2013
Demikian surat ini dibuat digunakan sebagaimana mestinya.
Palu, 5 June 2013
Tembusan:
1. Dekan Fakultas Ekonomi Untad
2. Ketua Jurusan Ekonomi Pembangunan
