I came across this article in one of my daily email blasts, either from The New England Journal of medicine daily mailer.
The article is titled “Lessons in Diabetes Care from Around the World”, and I thought it was very valuable and interesting on how it examined challenge in diabetes care, not just in the US but around the world- this article is pertaining specifically to Type 2 Diabetes. But I am confident that many of these challenges are still faced in regard to managing patients globally with Type 1.
The article notes that approximately 8.3% of the global population (380 million) are diagnosed with diabetes. The percentage seems small – but the number itself is quite large and quite alarming.
I have witnessed the challenges of managing the care of diabetes, on a much smaller scale of Chicago. One major thing – that this article addresses is getting patients involved, and getting them to understand the importance and implications of their disease.
Management of any chronic disease is always going to have many facets- it will impact patients, providers, cost to the patient needs to be assessed, and revenue or cost/benefit to clinics and providers is necessary to take into account.
And as I have said before on this blog – diabetes, when left to its own devices (left uncontrolled)- can create a cascade of complications, and other issues (kidney disease, heart disease, nerve damage, gastrointestinal and sexual dysfunction, etc) – that from there have additional needs in terms of nutrition implications, medications, education on that new disease, cost….
Speaking of cost…
-In 1997 the approximate total cost of treating diabetes in the United States alone was $44 billion, and according the the American Diabetes Association, these costs (as of March 6 2013) had risen to $245 billion in 2012.
This can be further broken down to: $176 billion in direct medical costs: medical care, drugs, insulin, and necessary medical supplies. Additionally these individuals may have higher premiums on life, and automobile insurance.
-For a low income family in India – with one adult having diabetes that as much as 25% of the total annual family income will be devoted to diabetes care, in the US it is 10%
-62.4% of the cost of diabetes in the United States is covered by the government (Medicare, Medicaid – and its associated subsidiaries, and the Military). The uninsured made up a small percentage (3.2%), and the remainder was private pay insurance (in 2012).
I would estimate that the percentage of government coverage has increased since 2012 with the health care reform.
Again diabetes is such a unique disease in the sense that it can cause a cascade of other diseases in its wake – leading to (again), greater costs (both direct and indirect – i.e. time away from work, decreased productivity etc).
So back to the specific challenges this article discusses:
1) There is a NEED to change our current patient care paradigm
2) ENGAGING patients to promote healthy behaviors
3) Implementing more technology for improved measurement
4) A more sustainable payment system
Looking at all of these together (in my mind) presents not only an ideal, but also a paradox. The first point – is talking about getting away from the model of volume based (as many patients as possible) to a completely patient centered experience, all the while creating an environement where patients are able to get the education they need (point 2)- because in order for patients to promote healthy behaviors- many times- they need education on how to do that, and what healthy behaviors even are, and of course – a system in which the patients can AFFORD to do this, and the hospital/health care system/providers can be reimbursed. And lastly implementing good technology- this can have larger up-front costs, but pay off in volumes at the end of the day.
Where I work we use a system called Epic, this system has a component called MyChart, that allows patients to sign up and see parts of their medical history, and communicate with providers (provided that they are not directly emailing) the provider. Additionally when you implementing a higher quality of technology (in most cases), you’re more likely to be implementing “best practices”, and also data collection.
Even as I patient, my healthcare provider/healthcare system offers me a similar service, I can register in my online portal – and communicate with my physican…should I have the desire to do so.
I know compared to many of my posts – this post is a little “dry”. However, healthcare in general is a HUGE issue globally. Some countries definitely have a good thing going or at least better than the U.S. But it is a very real issue – for providers AND patients, and not just for people with diabetes.
One thing that I like about this article is that it does explore areas that are critical in changing, for better success and outcomes, however, a significant down sides is that the author doesn’t suggest any real solutions on moving forward, he is moreso identifying problems – valid ones, and I am in agreement with the author of this as well.
It will be interesting to see if and how these changes will evolve. Something I have noted from personal experience following the shift in Healthcare Reform in the last 18 months is that it has created an emphasis on volume in regard to patient loads – especially in the primary care setting.
I feel that this is another battle of quality of quantity, however on of the things that is “supposed to” make recent healthcare reform great is putting some “say” back onto the patients – in the sense of patient satisfaction surveys.
This will continue to be a debate – that will extend far beyond the politics of healthcare reform in the United States. Remember, this article points out that these are concerns are happening globally.
At this I’m not sure which will come first. A cure for diabetes, or a cure in regard to the issues noted above.