Opportunities for cost reduction in diabetic retinopathy treatment: case study from Mexico

A study was performed in order to explore the costs of treating diabetic retinopathy at a large eye hospital in Mexico with a view to identifying opportunities for improving efficiency. Clinical records of a random sample of 69 diabetic patients were reviewed for data on each patient's background, medical history, and treatment; and the costs of all resources utilized in each type of procedure provided were documented and priced. The resulting data on clinical costs was complemented by data on the private costs of treatment (medical fees, accommodation costs, transportation costs, and lost wages) that were gathered from patient interviews. The study found that the patients, who were generally poor, shouldered a substantial economic burden associated with treatment at the hospital; however, less than half this burden was in the form of fees. The rest involved other out-of-pocket expenditures on food, travel, and accommodation (45% of the total) and lost wages (10% of the total). Suggestions for reducing various of these costs without endangering treatment quality are presented. These include suggestions for reducing waiting time; reducing the number of patient visits required by increasing the strength of individual laser treatments, completing more procedures in a single visit, and reviewing hospital policy on fluoroangiograms; and increasing the chances for early and effective treatment by educating at-risk relatives accompanying the patients about the need for early treatment.