Health Insurance, Not Personal Wealth, Determines Which Diabetics Get Adequate Care
Reviewing survey data from Colombia, England, Scotland, the Islamic Republic of Iran, Mexico, Thailand, and the United States, Dr. Gakidou and colleagues report that as many as 62 per cent of all diabetics are not aware they have the condition, and even among diabetics who receive treatment, only 1 per cent (in Mexico) to 12 per cent (in the United States) actually achieve treatment goals.
Even worse, very few diabetics receive treatment for the high cholesterol and high blood pressure that can accelerate diabetic complications such as blindness, kidney failure, peripheral vascular disease, heart attack, and stroke. In the United States, 40 per cent of diabetics do not receive treatment for high blood pressure or high cholesterol. In Thailand, 88 per cent of diabetics do not receive treatment for these conditions.
How many people have diabetes and know they have it? How well does treatment work? Here are some statistical highlights:
- In Mexico, approximately 1 in 4 (24 per cent) men and 1 in 5 (21 per cent) of women over the age of 35 have type 1 or type 2 diabetes.
- In England, 20 per cent of men who have diabetes and 16 per cent of women who have diabetes receive effective treatment.
- In Scotland, only 1 in 20 adults over the age of 35 has diabetes, but of these, about 10 per cent get effective treatment.
- In the United States, a majority of diabetics are diagnosed, but only about 1 in 8 gets effective treatment.
Insurance Coverage Seems to Make the Difference in Diabetes CareDiabetes is a very expensive disease. Test strips alone can cost as much as US $150 a month. The retail price of a vial of insulin, and some diabetics use up to 2 vials a week, can be as much as US $120. In the USA, a typical diabetic checkup, recommended three or four times a year, can cost about $750 without insurance.
So it should not come as a great surprise that most people who have diabetes can't afford to pay all their treatment costs on their own. Except for the wealthiest people in the USA and UK, personal income does not relate to the effectiveness of diabetes care. Insurance does.
- In the United States, diabetics who have insurance are 45 per cent more likely to meet treatment goals that diabetics who do not have insurance.
- In Mexico, diabetics who had private insurance were more likely to get effective treatment than those who were covered by the Seguro Popular (social security clinics), and people who went to government clinics were more likely to get effective treatment than those who had to rely on charitable clinics or received no care at all.
- In Colombia, the higher the the level of insurance coverage, the better the treatment results.
- In England, where medical care is delivered through a national health care system, poorer people were actually more likely to get effective treatment than richer people. However, in Scotland, which has a separate national health care system, and which has not pursued initiatives to make diabetes medication more available, wealthier persons got better care than the poor.