The health economics of diabetes

Firstly, from a macro perspective, of the 23.5 trillion Yen for general medical expenditure in 1998, diabetes accounted for 1.03 trillion Yen, and has increased 4.5 times since 1998. However, direct costs compose less than half the cost-of-illness of diabetes, according to studies made in the United States and Sweden. Secondly, from a micro clinical economics perspective, using fundus examination screening intervals for diabetic retinopathy as an example, the marginal cost increased sharply as the frequency increased, and has been reported not to be justified for those in their seventies, regardless of their HbA_1c level. Thirdly, in regard to the modalities of payment, a "fixed-amount payment according to the severity of each outpatient", should be explored more, especially in the grading of each patient, maintenance of quality, and management of exceptional cases.