Ask anyone with diabetes. Testing blood sugar levels is a pain. It takes time, fingers become sore and the levels change during the day based on diet, exercise and other factors. They tolerate that because it is important. Managing blood sugar levels is critical to managing diabetes. Patients who test regularly can take steps to ensure their illness does not get worse, leading to serious problems like blindness and even amputation.
Now, the state of Oregon is considering dramatically changing the
standard of care for thousands of people with diabetes. The state’s
Health Evidence Review Commission is considering cutting the assistance
that patients receive that helps them afford test strips. This would
gravely impact the number of times patients test from three times a day
to once a week. You read that right. It would be a 95% cut in coverage
for this critical element of managing diabetes
There are many problems with this policy. Despite claiming it focuses on “health evidence,” this policy is not based on science. For testing to be relevant, patients need to understand how their
blood sugar levels vary based on diet, exercise, sleep, and numerous
other factors. Since levels can vary during the day, testing once a week
provides almost no useful information. Is the glucose level normal or
is it an unusual spike? It would be impossible to know. This is like driving a car with no gas gauge and no speedometer –
there is no relevant information to control the car or to get you to
your destination. This is why the American Diabetes Association and physicians who treat patients with diabetes recommend testing daily. What evidence did the state commission use to make this decision?
None. One member of the state panel making the decision simply guessed,
saying that diabetes patients test just for the sake of testing. He
said, “I’ve had patients that just go crazy testing themselves… They
just want to know, want to know. And it, it really makes no difference
in their care as far as I can see.”
Actual science, however, contradicts
that. What’s more, the panel’s own decision indicates they know it isn’t
correct. Included in the policy are nine exemptions for a range of
groups. Again, these groups were not chosen based on evidence but on
guesses. The policy is being justified on the grounds that it will cut costs.
Failure to manage diabetes, however, can – and will – lead to much more
Patients who do not monitor can quickly become hypoglycemic,
requiring a visit to the doctor, which takes time and money. Worse,
because testing only once a week can give misleading results, patients
can be encouraged to overuse health care, falsely thinking their blood
sugar is too high.
Worse yet, many will believe they are doing well because infrequent
testing gives them a false sense of security. These patients risk
expensive visits to the emergency room. It does not take very many such
visits before any savings from cutting coverage is eaten up. At a time when our health care policy is looking to expand access, it
makes little sense to tell those who now have coverage that critical
health care, like diabetes management, is not part of that coverage.
During the next year, Oregon will be making many decisions about how
to implement the Affordable Care Act. Deviating so dramatically from the
standard of care for diabetes would be a bad precedent to set as the
state looks for ways to provide quality health care. Rejecting these
cuts in care would send a clear message that Oregon will not put the
health of its residents at odds with health care policy.
Information source Here.
Dead patients do not cost the insurance system. Follow the money. It is cheaper to not have diabetic patients.
Post a Comment