Chronic disease costs from a patient’s perspective: A survey of patients with stroke, heart disease, and chronic kidney disease visiting a district hospital in Indonesia

Context: Chronic disease treatment can lead to catastrophic costs. Although most direct medical costs are covered by the National Health Insurance, direct nonmedical and indirect costs may be burdensome for patients. Aims: To estimate the cost of chronic diseases from a patient’s perspective. Methods: A total of 315 patients with stroke (n = 105), heart disease (n = 108), and chronic kidney disease (n = 102) visiting a district hospital in Yogyakarta Province in Indonesia were included in this study. Data were collected through interviews and analyzed using descriptive statistics. Significant differences in mean costs between different groups seeking healthcare facilities were determined using the Mann–Whitney U test. Results: The estimated total out-of-pocket (OOP) costs per patient within three months were IDR 3,411,662 (USD 227.4), IDR 632,665 (USD 42.2), and IDR 3,227,951 (USD 215.2) for stroke, heart disease, and chronic kidney disease, respectively. OOP costs for the three diseases accounted for 9–49% of minimum regional wages. Indirect costs were the highest costs contributing to the total OOP cost (33–64%), followed by direct medical costs (12–57%) and direct nonmedical costs (5–33%). Patients seeking additional treatment at other healthcare facilities tended to have significantly higher costs. Conclusions: This study showed that chronic diseases put a relatively high economic burden on patients. Additionally, seeking more healthcare facilities tends to increase costs.