Background: Diabetes mellitus is an obtrusive universal health emergency in developed and developing countries, including India. With the exponential rise of epidemiological conditions, the costs of treating and managing diabetes are on an upsurge. This study aimed to estimate the cost of diabetes and determine the determinants of the total cost among diabetic patients. Methods: This cross-sectional study was executed in the northern state of Punjab, India. It involves the multi-stage area sampling technique and data was collected through a self-structured questionnaire adapted following the “ WHO STEPS Surveillance ” manual. Mann–Whitney U and Kruskal–Wallis tests were performed to compare the cost differences in socio-demographic variables. Lastly, multiple linear regression was conducted to determine and evaluate the association of the dependent variable with numerous influential determinants. Results: The urban respondents' average direct and indirect costs are higher than rural respondents. Age manifests very eccentric results; the highest mean direct outpatient care expenditure of ₹52,104 was incurred by the respondents below 20 years of age. Gender, complications, income, history of diabetes and work status were statistically significant determinants of the total cost. Study reports a rapid increase in the median annual direct and indirect cost from ₹15,460 and ₹3572 in 1999 to ₹34,100 and ₹4200 in 2021. Conclusions: The present study highlights that the economic jeopardy of diabetes can be managed by educating people about diabetes and its associated risk factors. The economic burden of diabetes could be restrained by formulating new health policies and promoting the use of generic medicines. The result of the study directs that expenditure on outpatient care is to be reimbursed under the ‘ Ayushman Bharat-Sarbat Sehat Bima Yojana’ .

Health insurance can be an effective tool of personal protection. But India’s health insurance market still lags behind the other countries in terms of penetration. The present article identified the role of perceptions in the enrolment of health insurance among the urban informal sector of Punjab, India. First, data were obtained from the urban informal sector of Punjab. Then factor analysis was applied to identify the perceptions associated with enrolment of health insurance. After this, logistic regression was performed to determine the associations of identified perceptions with enrolment of health insurance. The present study identified 12 perceptions factors associated with health insurance enrolment of the informal sector in India. Out of the 12 factors, the logistic regression results proved that 8 were statistically significant influencers of health insurance enrolment decisions. The significant perceptions factors were lack of awareness about the need to buy health insurance; comprehensive coverage; income constraint; future contingencies and social obligations; lack of information; availability of subsidized government health care; linkage with government hospitals; and preference for government schemes. It was found that perceptions play a vital role in the household decisions to enrol for health insurance. Policy makers or marketers of health insurance policies should recognize the household perceptions as a potential barrier and try to develop a health insurance package as per the actual needs of the informal sector (low income) in India.

Sustainable ecotourism is tourism that meets the prerequisites of responsible travel and environmental conservation and improves the financial well-being of local businesses. This study investigates the role of ecotourism policy, innovation, and social media as direct antecedents of sustainable ecotourism development and the moderating role of environmental philanthropy. A quantitative process was used, and existing validated scales were used to develop the survey instrument. A partial least squares path modeling technique was utilized to test the model. The study results show that ecotourism policy, innovation, and social media significantly influence ecotourism development, and environmental munificence determines the moderating role. This study suggests that tourism firms and local businesses should focus more on innovations and their applications. The role of social media and influences should also be extensively promoted amongst locals, tourists, and firms to achieve sustainable ecotourism development. This study extends the research by using the sustainable tourism theory as the theoretical foundation and validating the moderating role of environmental munificence between innovation and sustainable ecotourism development.

Background & objectives: Non-communicable diseases have been designated as ‘public health priority’ globally, and they are accountable for debility, morbidity, and mortality. Thus, the present study aims to estimate the out-of-pocket payment, catastrophic healthcare expenditures and household wage loss. Methods: Field research was conducted with an adapted survey questionnaire. Data from 576 individuals from various healthcare facilities in Punjab were collected using a convenience sampling approach. The out-of-pocket and catastrophic healthcare expenditures (CHE) were estimated using descriptive statistics and indices, viz., headcount overshoot and mean positive overshoot. Lastly, logistic regression models were applied to identify determinants of catastrophic health expenditure. Results: The study findings showed that most respondents incurred a high out-of-pocket payment for inpatient care. Further, at any threshold level, the incidence of catastrophic health was highest among diabetic patients. The intensity of catastrophic healthcare expenditure with diabetes and hypertension exceeded the five per cent threshold bracket. Logistic regression results revealed that the odds of incurring catastrophic healthcare expenditure were highest among respondents diagnosed with diabetes, chronic obstructive pulmonary disease (COPD), and stroke. Interpretation & conclusions: The study recommends that the government health insurance scheme ‘Ayushman Bharat-Mukh Mantri Sehat Bima Yojana (AB-MMSBY)’ must include outpatient and pre- and post-diagnostic costs incurred by respondents diagnosed with cardiovascular disease (CVD), COPD, and diabetes in Punjab. Therefore, respondents with diabetes mellitus (i.e., specifically type-1 patients) must be covered under health insurance benefits.

The article provides estimates of economic burden of diabetes among women. The study was based on primary data collected from Jalandhar. The article examines the direct, indirect and intangible cost of diabetes. The result indicates that mean cost of outpatient care of consultation, lab investigations, medicines, special diet and transport was ₹203.53, ₹535.50, ₹515.0, ₹258.80 and ₹120.30, respectively. While, mean cost of inpatient care of consultation, lab investigations, room charges, medicines, special diet and transport was ₹1157.00, ₹1468.75, ₹1354.50, ₹4175.50, ₹680.0 and ₹278.65, respectively. The analysis shows that the mean cost of inpatient care was higher than that of outpatient care. Intangible cost of diabetes involved reduced food consumption, borrowing from neighbours/relatives, decreased non-food consumption, decreased savings, decreased social obligations/functions, stopped purchase/expansion of house, sale of household assets, stopped medical treatment of other members in the family and stopped the purchase of consumer durables. These figures are compelling enough to stimulate government to take corrective actions to address the risk factors that contribute to diabetes. Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment to reverse this trend. Healthcare policy planners must anticipate and respond to socio-economic implications, ideally through preventive as well as curative measures.