| Diabetes takes a toll on more than your health – it can hit your pocketbook as well. Now advocates are working to help everyone afford the best care available. |
OVER THE PAST FEW YEARS, the treatment of diabetes has advanced dramatically. From more effective types of insulin to optimal blood glucose testing guidelines to new medications for complications, health professionals and researchers are discovering ways to help people with diabetes live healthier lives.
Unfortunately, most of the advances come at a price – literally.And many people are having a hard time paying it.
Christine Smillie, national associate director of public policy and government relations for the Canadian Diabetes Association, says supplies and medications for a person with diabetes can reach upwards of $5,000 annually. Typical costs incurred for people with diabetes include blood glucose test strips and meters, insulin and syringes or oral diabetes medications. Indirect costs are also involved, such as good food (nutrition is vital in diabetes management), drugs to treat complications such as high blood pressure and high cholesterol, frequent medical visits (including time off work), and sometimes even travel to see specialists.
“Most provincial and territorial drug plans cover some costs, and there is usually assistance for seniors and people on very low incomes or social assistance, but it’s generally not adequate,” says Smillie. “If you don’t have private insurance or coverage through work, it can be difficult.”
Although most people understand the potential health consequences of ignoring their diabetes care – kidney disease, heart attacks, blindness, limb amputation – it’s not uncommon for those with financial struggles to ration their medication, forego regular blood glucose testing, or eat a less-than-optimal diet.
For example, an elderly person with diabetes recently confided to Saskatoon diabetes nurse-educator Judi Whiting that she doesn’t always fill her prescriptions.She simply can’t afford it.
“This woman is in her 70s, on a fixed income, and she’s only one of an increasing number of seniors who are getting [type 2] diabetes,” says Whiting, who has asked the Canadian Diabetes Association to help her patient obtain financial assistance. “It’s a real shame when people have made a personal commitment to keeping healthy, and new and promising drugs are available, but they’re struggling to make ends meet.”
Such stories don’t sit well with the Canadian Diabetes Association, which last year produced a report card rating provinces and territories for their support of people with diabetes – and found them sadly lacking.
One of the most disturbing trends identified by the report is the high cost and inequity of access to drugs, supplies and devices. Some provinces provide insulin for low-income people with type 1 diabetes, but not the syringes to administer it. Three provinces – Nova Scotia, New Brunswick and Newfoundland – don’t even cover the insulin.Yet others provide insulin and syringes, but not test strips.
Even more confusing, says Smillie, is that some support may come from a health ministry, and other support from social assistance programs in a different government ministry. More relief, albeit minor, may come from a federal government tax credit – if you qualify.
The report card’s results prompted the Association to call on governments to commit to a strategy that ensures costs to the individual for diabetes medications and supplies aren’t a barrier to managing the disease.
“Financial support now means avoiding significant costs later,” says Smillie. Just one person on kidney dialysis – a complication of poorly managed diabetes – costs the health system about $50,000 a year. The overall annual cost of diabetes in Canada is a staggering $9 billion.
Canadian Diabetes Association divisions across the country are joining the advocacy effort. In Alberta, a postcard campaign encouraged people with diabetes to write to the health minister with their personal stories. In British Columbia, financial coverage was among the top concerns raised during 10 province-wide community consultations – a message that’s since been communicated strongly to the government. At an Association-hosted dinner in Nova Scotia, the health minister and 12 members of the Legislative Assembly listened to heartfelt presentations by three low-income people with diabetes.
Bonnie Thoen, 44, is one of several advocates taking up the cause in Saskatchewan, where she lives with her husband and 16-year-old daughter. As a flight attendant manager for 22 years, Thoen had medical coverage for her type 1 diabetes – which she developed at the age of eight – through her employer. Now running her own business, she foots the bill for her medical supplies.
“I consider myself lucky,” says Thoen, who devotes her volunteer hours to speaking on diabetes advocacy issues to government representatives. “The cost of managing my diabetes definitely figures into my family’s decisions, but there are many people who are worse off than I am.
“I firmly believe everyone with diabetes should have the choice to live a healthy life,” she continues. “And right now, that’s not an option for many people.”
Thoen’s blood glucose fluctuates so rapidly, she recently purchased a $5,000 insulin pump which she wears 24 hours a day. “The pump really increased my quality of life – but they’re not covered by most medical plans,” laments Thoen. In fact, only the Northwest Territories government covers the cost of insulin pumps and supplies.
Further illustrating the “good news, bad news” scenario, Thoen says that as a child she tested her blood glucose once a day. “Now we know it’s beneficial to test more frequently. So your health is better, but at (up to) $1 a time, it’s more expensive!”
Add exercise to your life – highly recommended for people with diabetes – and you further increase the costs of blood glucose testing, which should be done before and after activity.
And while you can shop around for reasonably priced fruits and vegetables, comparison shopping probably won’t save you much on diabetes supplies. You might get a minor discount on test strips or needles,” says Whiting, “but the cost of medications is pretty standard.”
Whiting urges people not to give up, however. The struggle is worth it – there are long-term benefits to your health.” She recommends talking with a physician or other health professionals – including pharmacist, if medications are involved. “They may know of assistance you can apply for, or they may have suggestions on how to do things differently,” she says.
You can also contact your local Canadian Diabetes Association office for assistance, suggests Smillie. Staff have a good handle on what financial assistance available locally and how to apply for it.”
Check in with the Canadian Diabetes Association if you’re interested in joining Thoen and other volunteers in advocacy efforts, too – there’s an advocacy committee in every province and territory, each with plan of action to encourage the government to provide financial aid for people who live with diabetes.
“I’d say we’re making good progress towards changes,” says Smillie. “But it’s never too late for others to get involved – it just makes our voice that much stronger.”
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