Health insurance and diabetes management outcomes

Health Insurance and Diabetes

Diabetes is a disease that is characterized by hyperglycemia, or high blood sugar levels. The disease can affect anyone, including children as young as a few years old, and for the most part, the disease is self-managed. In other words, the diabetic must learn the ways and means of managing this chronic ailment on his own, so that he may be able to live a full and productive life. However, this may be possible only if he can avail of health insurance, which would help him monetarily, in acquiring testing and other equipment that are necessary to monitor his disease. This paper examines whether and how health insurance helps the diabetic, or not.

Diabetes is a disease that has to be, for the most part, self-managed and coped with on one's own. In order to remain healthy and monitor his disease with the equipment widely available today, a diabetic must have easy access to supplies like test strips, meters, and to insulin. When a diabetic has a health insurance policy, then in general, this would be sufficient to cover the necessary supplies. However, it must be remembered that for an individual who is suffering from diabetes, it is quite difficult, if not impossible, to obtain health and life insurance, on the one hand, and on the other hand, to keep them. (Health Insurance Information for People with Diabetes)

Recently, on February 8th 2005, the American Diabetes Association and the Georgetown University together submitted a Report on the crisis that has been brewing for some time now, as far as health insurance for diabetics is concerned. Entitled, "Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes," the Report focuses primarily on the numerous barriers that exist for a diabetic in America, when he needs to access and avail of adequate and affordable health insurance, which would help him manage and deal with his lifelong disease in a better way. (ADA and Georgetown University Health Insurance Research) In short, it can be stated that if a diabetic sees his disease as a sort of daily challenge, wherein he tries to deal with it with the help and support of his friends and family, then it means that he is managing well indeed. This would also mean that he has taken the responsibility and the duty of self-managing the disease as effectively as it may be possible to do so, and that he has learnt to follow a strict regime in monitoring the disease, as well as learning all he can about diabetes and how and where to avail of the tools needed to manage it effectively and efficiently. (Lundstrom; Rossini, 2004)

Health Insurance is in truth a 'must' for an individual who is suffering from diabetes and the main reason for this is that supplies and medication can be prohibitively expensive, and even if the insurance is able to cover these expenses, the insurance companies also need a co-payment. Perhaps one of the better deals that are offered by health insurance is that which is covered in part by the company that the individual is working for. (Lundstrom; Rossini, 2004) In general, most health care providers are expected to supply lists of patients with diabetes, so that health insurance companies would have a better idea on the condition of the patient, and how he manages his diabetes, at the time of application for the insurance. (Rowell; Green, 2003)

Report by the American Diabetes Association states that Americans, who are suffering from diabetes, and other similarly chronic conditions, are more likely to lose their health insurance coverage, than individuals who are not diabetic. Perhaps, states the report, the reason for this may be that in general, people who suffer from chronic ailments usually run the danger of incurring a high medical debt, and at times, these patients may even be forced into bankruptcy, because they had to manage their disease as well as they could. (Diabetes Patients have difficulty maintaining health insurance coverage, often go uninsured)

We shall now deal with a touching case study of a patient who was diagnosed with diabetes type 2, and what he did to cope with the disease, and how he went about trying to get health insurance, which would help him manage the chronic ailment better. A self-employed man, had quit his previous job in order to start his own business, and he found to his dismay that the cost of managing diabetes, for himself, as well as for his wife, who was also suffering from the same disease, had escalated to almost double the original cost, and in addition, this happened every three months. When he found that the amount had touched a steep $16,000 a year, which was an amount equal to his annual income, he found that he had to shut down his newly opened self-owned business, and work at a government agency, just so that he would be able to manage the costs of health insurance for his diabetes. (Valentine, 1998)

According to the article in the Los Angeles Times entitled, 'Working without a Net', in which this case study appeared, there is a growing number of people who are stuck in a job that they relay hate, just because of the fact that they have no other option than this, if they wished to handle their diabetes, and also keep up with their enormous health insurance payments. This means that not only is this bad for business, because if people hate their job, then they are naturally bound to be less than productive and efficient in what they do, but it is also symbolic of the fact that all joy and happiness would have gone out of their jobs for these people, because they would be bound and held a prisoner to health insurance payments of managing diabetes and other similar chronic diseases. (Valentine, 1998)

However, it must also be remembered that even if a person enjoyed his job, and was perfectly happy with it, his health insurance would still eat away at his deductibles, and his co-payments would still increase. The reason for this is that medical charges are indeed getting way out of hand, and perhaps even out of sight. For example, in the article, a woman who had had a miscarriage was faced with paying a bill totaling about $6,000, which included a single night's stay in the hospital, and charges such as 14 for about 4 ounces of mouthwash, and $17 for a sanitary pad that would normally cost about fifteen cents. Why are medical charges so very exorbitant and unaffordable, more often than not? Perhaps the main reason is that only about one fourth of all hospital patients actually have health and medical insurance, and this can e taken to mean that these people, who do have health insurance, are in actuality paying not only for their own care, but also for those people who do not have health care insurance.

As a matter of fact, it is a well-known fact that these people are compensating for those people on Medicaid and Medicare, whose payments are set by the government, the amounts of which are generally considered to be inadequate by the standards maintained by hospitals. This is a strange phenomenon; it is almost as if one enjoys a meal at a restaurant, and then finds to his dismay that he has been charged for the food that he has eaten, as well as that which has been consumed by three other diners at the same restaurant, who did not have the money to pay for their food. (Valentine, 1998)

However, it must be noted that today, Medicaid is intent on improving its plans for covering people suffering from diabetes. In fact, in the year 1997, Congress enacted legislation to cover diabetics, diabetes education, and to provide meters and also blood sugar strips for all diabetics. Many diabetics consider this legislation to be a great breakthrough, because it would pay for finding out what exactly the diabetes is doing to one's body, although it must be stated here that Medicaid does not pay for insulin, syringes and various other paraphernalia that would keep the blood sugar levels under control. There are several different kinds of insurance plans, and a patient must conduct a thorough research on the types available to help him deal with his disease, so that he could choose the option that would fit him best. In a health insurance plan, for example, a diabetic would have many options, like when he has to take a lot of medications, the Health Maintenance Organization that he belongs to would help him with nominal co-payments of $5 to $10, on each prescription. (Damocles; Bykin, 2004)

However, the innate disadvantage in this plan is that it generally works under a particular formulary, which in essence means that the committee would select the medications that the patient must take. The choices are based on the basic effectiveness of the medication, and on the price, and in order to save costs, as they must, the committee selects one or two drugs, from each classification, and this would mean that physicians would not be allowed to choose from a broad variety of brand names when prescribing medication for their diabetic patients. What this in essence means is that the patient would not be able to choose his own brands of medication; he must only buy what the committee has recommended, otherwise, he would lose out on his health insurance payments.

A woman who faced a problem similar to that mentioned above talks about her experience as a diabetic. She said that when the health insurance company stated that they would be able to pay for a higher priced drug to control diabetes, than the one that the committee recommended, she argued and fought it out with the company, until, eventually, they agreed, albeit reluctantly, to pay for the higher priced drug 'Glucophage.' Her experience was that as soon as she started on hits drug, she found to her amazement that her sugar levels had started to drop considerably, and that her vision, which had been deteriorating for quite some time, gradually started to return to normal. Her problems were not over, however. (Damocles; Bykin, 2004)

According to this woman, when her employers became aware of the fact that she had experienced a loss of vision because of her diabetes, they started to consider her more of a liability than an asset, especially in relation to the steep costs that the company would have to incur in term of health insurance payments and other benefits for her. She was fired, and she found herself with no job, and also no health insurance, and with a chronic disease to manage. Since she had already exhausted all her savings in trying to pay for her medications, and really could not afford to pay for her insurance premiums any more, she found that she was in a tight quandary indeed. There were no jobs available for an over-qualified fifty-five-year-old, and by the time she found a small job, she was off her all important medication for almost a year, because of which she lost her vision, and developed serious cataracts. (Damocles; Bykin, 2004)

In America today, there are almost eight percent children and adults, who live without life and health insurance, and it is a fact that the uninsured population will continue to grow steadily over the next few years, unless some sort of action is taken by the government and by health insurance companies. (Iom, 2004) It must be remembered that health care in the United States is considered to be one of the most expensive in the entire world today, and in general, access to health care is dictated and controlled by private and government based insurance companies. As far as the diabetic population is concerned, about 10% to12% is left uncovered by health insurance. (Ekoe; Zimmet; Williams, 2001)

For a diabetic, as mentioned earlier, the costs of managing the disease, seeking health care, and insurance can be prohibitive indeed, and a diabetic, on an average, spends about $13,243, when compared to a healthy person, who spends about $2,560. This is the reason why accessing health insurance is extremely important for an individual with diabetes; costs must not deter the person from seeking out the best medical care available to him. (Yu; Stjernholm; Munier, 2004) This is especially true where minorities, such as Hispanics and ethnic races are concerned. (United States Congress; Select Committee on Aging, 1992) The U.S. Health Care system is in general oriented towards the reactive treatment of disease, and as a direct result, the costs of providing health care is largely motivated by illness related care. (Clark; Cefalu, 2000)

Health insurance companies must gear up to deal better with diabetics, and in certain states, like for example in Montana state law allows health insurance companies to turn people who approach them for insurance, at will, based on the status of their health, and in most cases, diabetics are considered to be 'uninsurable'. (Montana: American Diabetes Association) Obtaining insurance cover can therefore be an uphill task for a diabetic, and some agencies, like for example, the Diabetes Federation of Ireland in conjunction with ERM Financial Services have managed to negotiate, with insurance underwriters, a number of schemes that a diabetic would find useful in managing his disease efficiently, as also in availing of health insurance benefits. Some of these are: Motor Insurance, Travel Insurance, Group specified Illness and life cover, Group Personal Accident Cover Mortgage & Mortgage Protection Facility and Household Insurance Cover. (Diabetes & Insurance: Diabetes Federation of Ireland)