Economic Burden for Productive Age Malaria Patient:

Case Study in Mandailing Natal Regency

Destanul Aulia

, Intan Permata Sari

and Sri Fajar Ayu

Departement of Administration and Health Policy, Faculty of Public Health, University of Sumatera Utara, Jl. Universitas

No. 21 Kampus USU, Medan 20155, Indonesia

Departement of Agribusiness , Faculty of Agriculture, University of Sumatera Utara, Jl. A. Sofian No. 3 Kampus USU ,

Medan 20155, Indonesia

Keywords: Economic burden, malaria, inpatien, productive age, non productives age.

Abstract: Mandailing Natal is one of the endemic areas of malaria in Sumatera Utara Province. Besides having a high

transmission risk, malaria disease also impacts on patient's economy, both in productive and non-productive

age. This was a survey study for malaria inpatients from July to December 2017, using quantitative methods

calculated based on direct and indirect costs during treatment, then comparing the economics of productive

and unproductive age inpatient. Direct costs include inpatient fees, specialist doctor's visit, doctor's and

room services, personal hygiene officer, laboratory, medicine, and administration. Indirect costs include

transport, extra meals of patient and patient roommate, productivity loss of patient and patient roommate.

The purpose of this study was to compare the economic burden in productive and unproductive age patients

during treatment. The results showed that the total economic loss of productive age patients was

Rp1,907,116 and the total economic loss of unproductive age patients was Rp1,845,499. Total losses in

malaria patients of productive and non-productive age are almost the same, with a difference Rp61,667

more in productive age. The high malaria sufferer becomes a high economic burden for the patient, because

the productive age patient will lose productive time to work, and non productive age patient will be an

additional burden for the family. Mandailing Natal Government needs to develop a comprehensive strategy

and policy for the development and improvement of environmental sanitation and community behaviour,

because Mandailing Natal Regency is a malaria endemic area with high transmission risk affecting family

health and economy.

1 INTRODUCTION

Health development in Indonesia is currently faced

with triple burden disease and a condition with the

infectious diseases is still a public health problem.

Non-communicable diseases isincreasing, by the

emergence of new diseases. One type of infectious

infection disease that is of particular concern is

malaria. Malaria is one of the major public health

challenges in Indonesia, especially for rural

communities. According to (Ministry of Health,

Republic of Indonesia, 2018)malaria is an infectious

disease caused by parasites (protozoa) of the

plasmodium genus, which can be transmitted

through anopheles mosquito bites. Accorded to

Sorontou (Sorontou, 2013), malaria actually can be

prevented by individuals and communities by

treating susceptible persons and residents in endemic

areas, providing prophylactic treatment to

individuals entering malaria endemic areas,

eradicating the nest and anopheles mosquitoes using

suitable insecticides, using bed nets when sleep or

using repellent that is applied to the skin if it is

outside the house at night.

Besides disturbing health, malaria can also cause

economic burden. This can happen because a family

prioritized malaria treatment. Malaria patients in

Mandailing Natal District are dominated by

productive age with a 58% percentage compared

with unproductive age; this will be an economic

burden for society because patients and families of

productive age will lose time to work during malaria

treatment. While unproductive age patients will be

extra burden for the family.

The impact of economic losses caused by

malaria is very influential on the economy of society

138

Aulia, D., Sari, I. and Ayu, S.

Economic Burden for Productive Age Malaria Patient: Case Study in Mandailing Natal Regency.

DOI: 10.5220/0008883201380142

In Proceedings of the 7th International Conference on Multidisciplinary Research (ICMR 2018) - , pages 138-142

ISBN: 978-989-758-437-4

and government then it is important to conduct cost

analysis against malaria disease. Cost analysis of

malaria is a method to calculate the amount of

casualty (cost, cost) in monetary unit (rupiah), direct

cost or indirect cost, to reach the objective (Ministry

of Health RI, 2013).

According to WHO (WHO,2017), the cost of

care for malaria patients has increased by 4% from

232 million US dollars in 2015 to 241 million US

dollars by 2016. About 400 million US dollars each

year is needed to finance as a whole the prevention

and treatment of malaria in Indonesia, and 100

million US dollars to support health systems and

operations (UNICEF, 2009).

Based on data from the Central Bureau of

Statistics (BPS) on the results of the economic

census in 2016, the economy of Mandailing Natal

Regency decreased from 6.49% in 2014 to 6.21% in

2015. In addition, 93.47% of its workforce is in the

sector informal, This condition shows the level of

wage of the working population in the informal

sector is quite low, meaning that if the population is

faced with the high risk of transmission of malaria

then it is probable that the economic burden of

suffering from the disease is very vulnerable faced

by the community.

Analysis of malaria treatment cost is considered

very necessary to be done in Mandailing Natal

District because this area becomes one of malaria

endemic areas, so the risk of transmission of malaria

disease is very large and then affect the level of

morbidity and mortality.

2 METHODS

This study was a survey of malarial inpatients from

July to December 2017, using quantitative methods

calculated based on direct cost and indirect costs

during treatment, then comparing the economic

burden on the patient's age productivity and non-

productivity. Direct costs include inpatient fees,

specialist doctor's visit, doctor's services and room

attendant, personal hygiene officer, laboratory,

medicine, and administration. Indirect costs include

transport, patient extra meals and patient care, as

well as patient and patient productivity costs of

missing patients.

The inclusion criteria for sample selection are:

(1) Patients (BPJS and general) with the primary

diagnosis of uncomplicated malaria hospitalized in

July - December 2017; (2) Patients with complete

data (age, sex, LOS, treatment class, diagnosis) and

drug (drug name) and (3) Domiciled in Mandailing

Natal District.

3 RESULT

Table 1: Characteristics of respondents.

Characteristic Number

F %

Aged (Years)

a. 0-5

15 23

b. 16-11

10 15

c. 12-17

6 9

d. 18-23

6 9

e. 24-29

6 9

f. 30-35

3 5

g. 36-41

6 9

h. 42-47

4 6

i. 48-53

6 9

j. 54-59

2 3

k. 60-65

2 3

l. >65

0 0

Sex

a. Male

40 61

b. Female

26 39

Job

a. Non-Job

16 24

b. IRT

1 1

c. PNS

1 1

d. Privite Worker

3 4

e. Self-enterprise

5 8

f. Farmer

3 5

g. Merchant

7 11

h. Worker

6 9

i. Students

19 29

j. Others

5 8

Income

a. <Rp. 1.000.000

5 16

b. Rp1.000.000-2.000.000

14 45

c. >Rp. 2.000.000

12 39

Inpatient Class

a. VVIP

4 6

b. VIP

3 5

c. Class I

18 27

d. Class II

14 21

e. Class III

27 41

Assurance

a. BPJS

36 55

b. Genaral

30 45

LOS

a. <3 days

33 50

b. 3-5 days

32 48

c. >5 days

1 2

Economic Burden for Productive Age Malaria Patient: Case Study in Mandailing Natal Regency

139

Table 2: Direct cost of general inpatien.

Direct Cost

Class (Rp)

VVIP VIP Class I Class II Class III

Drug 454675 273955 263770 5747000 1024755

dr Visiting 220000 120000 165000 190000 140000

Room worker 330000 240000 330000 510000 840000

Nurse 55000 40000 50000 95000 140000

Lab 440000 320000 400000 760000 1120000

Adm 60000 45000 60000 120000 165000

Inpatien 1815000 1120000 1200000 1140000 840000

Total 3374675 2158955 2468770 3389700 4269755

Average 843669 719652 617103 431213 388160

Table 3: Indirect cost of general inpatien.

Indirect Cost

Class (Rp)

VVIP VIP Class I Class II Class III

Transport

63000 159000 197000 305000 466000

Room-mate

538000 450000 482000 140000 762000

Loss of Productivity

1016000 1020000 624500 1273500 1340000

Total

1617000 1629000 1303500 1718500 2568000

Average

404250 543000 325875 214812 233455

Table 4: Direct costs of BPJS patients.

Class Total cost (Rp)

I 2.964.700

II 2.541.200

III 2.117.600

Table 5: Indirect cost of BPJS inpatient.

Indirect Cost

Total Cost

Class I

(n=14)

Class II

(n=6)

Kelas III

(n=16)

Transport

Rp.535.000 Rp.247.000 Rp.533.000

Room-mate

Rp.1.298.000 Rp.930.000 Rp.1.619.000

Productivity

Rp.3.994.500 Rp.2.144.000 Rp.2.428.750

Total

Rp.5.827.500 Rp.3.321.000 Rp.4.580.750

Average

Rp.416.250 Rp.553.500 Rp.286.297

Table 6: Average cost of malaria treatment.

Outcome Total

Direct cost Indirect cost

General Rp.525.650 Rp.315.067 Rp.840.717

BPJS Rp.2.517.628 Rp.381.368 Rp. 2.898.996

ICMR 2018 - International Conference on Multidisciplinary Research

140

Table 7: Average malaria costs in productive aged.

Outcome Total

Direct Cost Indirect Cost

General Rp.609.037 Rp.369.038 Rp.978.076

BPJS Rp.2.416.582 Rp.407.926 Rp. 2.836.156

Table 8: Average malaria costs in non-productive aged.

Guaranted

Direct cost Indirect Cost Total

General Rp.461.883 Rp.273.794 Rp.735.677

BPJS Rp.2.608.037 Rp.347.184 Rp. 2.955.221

4 DISCUSSION

4.1 Characteristics of respondents

The results showed that in the productive age

category (15-65 years) there was a higher number

compared with the unproductive age of reaching

58%. The high number of malaria sufferers at the

productive age will have a greater impact on the

economic losses for both the patient and the family

and the government.Based on sex, it turns out that

most respondents who suffer from malaria is male

amounted to 40 people (61%), The cause of the large

number of male respondents exposed to malaria is

associated with a higher risk of malaria in males due

to environmental risks and working time and this is

will be a problem because male with productive age

is majority worker in Mandailing Natal. The income

of respondents who are productive age is

Rp.1.000.000 - Rp.2.000.000, - per month as 14

people (45%). average income of respondent is

Rp.1.683.710, - / month, this income of respondents

who are still below of regional income of

Mandailing Natal Regency in 2017 amounting to

Rp. 2,096,250, -. This indicates that the respondent

has limitations in saving his income every month

because the money is only enough for the daily

needs, so it will become an economic burden if

malaria occurs.Under the guarantor, patients are

guaranteed by BPJS more than the general patients.

While the type of treatment class is selected.

Mostpatients are in the third class is 41%. This is

because patients who are hospitalized via BPJS are

as much as 44%, a beneficiary contribution (PBI).

While in general patients, as many as 37% of

respondents chose class I as an option to get

inpatient services due to the cost of maintenance that

is quite affordable.Based on the long days of

hospitalization (long of stay), most of the 50% of

respondents treated ranged from 1-2 days. While the

overall average is for 3 days of care.

4.2 Total economic losses in general

patients (direct cost + indirect cost)

The total cost of the respondents directly related to

the treatment (direct cost) is Rp.15.769.495, - with

an average of Rp.525.650, In addition, respondents

also incur costs associated with loss of productivity

(indirect cost) with a total of Rp.8.947.000, - and an

average of Rp.315.067, -. The total economic loss of

the patient (general) as a whole is Rp. 23,673,470, -

and on average Rp. 840.717.

4.3 Total economic losses in patients of

bpjs (direct cost + indirect cost)

The total cost incurred by BPJS in the treatment

(direct cost) of malaria patients is Rp. 30.634.600, -

with an average of Rp. 2,517,628. In addition,

patients also incur costs associated with loss of

productivity (indirect cost) with a total of Rp.

13,729,250, - and on average Rp.381.368.

4.4 Cost comparison of productive and

unproductive age

The results showed that the total economic loss of

patients of productive age is Rp1,907,116 and total

economic losses of unproductive age patients is

Rp1,845,499. Total losses in malaria patients of

productive and non-productive age are almost the

same, with a difference of Rp61,667 more in

productive age, respondents of productive age and

have worked mostly as traders and labourers. If

malaria occurs they cannot work during

hospitalization and will lose their income. The cost

of productivity loss in this study is limited only

when the patient is admitted in hospital, as well as

Economic Burden for Productive Age Malaria Patient: Case Study in Mandailing Natal Regency

141

the companion calculated based on the length of

time he accompanies the patient in the room. The

total cost of loss of productivity will surely be

greater considering that after the patient leaves

treatment room, it still takes a few more days for

rehabilitation and rest until it is fully recovered and

ready to return to work as usual.The results showed

the average income of patients of productive age lost

with the length of 3 day care is Rp.176.927, - and

companyRp. 88146, -. While the unproductive age

patient does not lose income because there is no

wok, but the patient's family recovering their

treatment fee is lost with an average of Rp.136.836.

5 CONCLUSION

1. Based on the results of the study of malaria

patients hospitalized at RSUD Panyabungan

period July - December 2017 productive age

reaches 58% and male patients 61%.

2. Based on the type of work in productive-aged

patients, most of them are traders and labourers

and most unproductive age is student.

3. Total economic loss of patients (general) as a

whole is Rp. 23.673.470, - with an average of

Rp. 840.717, -. Total economic loss of patients

(BPJS) and government is Rp. 104,363,850, -

with an average of Rp. 2.898.996.

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