Out-of-pocket medical expenses create a health gap for diabetes patients

For many patients, diabetes is more than a chronic health issue. It’s also a chronic financial issue. Patients are responsible for costs such as medication, blood glucose testing meters, test strips and insulin pumps. A 2011 report from the Canadian Diabetes Association notes that on average, Canadians with diabetes spend more than three per cent of their income – over $1,500 per year – on medical costs related to diabetes.

That financial burden can create a serious health gap.

“In that same report, 57 per cent of patients said they didn’t adhere with treatment just because of costs,” says Dr. Jenny Wang, an endocrinology fellow at Women’s College Hospital (WCH).

Not following their treatment plan puts patients at risk for serious complications in the future.

“Some of these complications can be quite devastating, including kidney failure, stroke or heart attack,” explains Dr. Calvin Ke, an endocrinology fellow at WCH. “In order to prevent this, people with diabetes need to be empowered to manage their condition, which can be very difficult if there are financial barriers.”

Canadian research has shown that people with low incomes are more likely to develop diabetes than people in higher income groups. Even under a universal healthcare system, patients with diabetes with low incomes are more likely to be hospitalized with complications than those with higher incomes.

“There is very extensive literature about the health gap around diabetes. Studies have shown that people with diabetes in the lowest socioeconomic class are over 50 per cent more likely to have complications such as heart attack and stroke compared to those in the highest socioeconomic class,” Dr. Ke says. “In Canada, it’s not acceptable that people should have worse health outcomes based on their socioeconomic status.”

While assistance may be available to patients with diabetes with low incomes, patients and healthcare professionals may not know how or where to get help.

To address that health gap, the Interprofessional Diabetes Education and Advocacy (IDEA) group at WCH has created the Diabetes Resource Manual, which lists support programs and financial assistance for patients with diabetes in Ontario. The comprehensive manual includes information on resources for everything from nutrition to vision care to tax credits. It is available on the WCH Centre for Integrated Diabetes Care web page.

The manual got its start when Cheryl Harris-Taylor, registered social worker for chronic disease management at WCH, identified a need. Some patients could not afford the costs of medications and equipment, and also needed help finding and accessing treatments and supplies.

“Many patients don’t have access to resources, or don’t know where to get foot care or where to get diabetes supplies. Some doctors and healthcare professionals may not know about all the resources and programs available,” Harris-Taylor says. “I decided to compile everything in my folders to make a package for patients.”

The IDEA group at WCH built on that package by gathering and consolidating further information from sources such as the Canadian Diabetes Association. The result is a thorough guide for diabetes patients and health practitioners.

“This is a resource patients can use to access information, and that healthcare professionals can use so their patients can get help faster,” Harris-Taylor says.

The IDEA Group includes Harris-Taylor, a social work intern, five endocrinology fellows (including Dr. Wang and Dr. Ke), and endocrinologist Dr. Sheila Laredo, chief of staff at WCH.

“We try to address issues that we’ve encountered within our clinical practice, covering the spectrum of management that patients need for their care,” says Dr. Wang. “Diabetes management is very lifestyle-based, so socioeconomic issues can play a large role.”

Economic issues can affect diabetes care in basic areas such as shelter and nutrition, not just paying for medication or funding expensive items like insulin pumps.

“Some patients may live in shelters, which makes preserving their insulin medication very challenging,” she says, explaining that insulin requires refrigeration. “When I was talking to one of my patients about eating a healthy diet, she told me that she couldn’t afford healthy food. That was when I realized just how important it is to make sure people have the resources to adhere to the treatment course they need for their health.”

The Diabetes Resource Manual is designed to help patients access those resources.

References

Canadian Diabetes Association. The Burden of Out-of-pocket Costs for Canadians with Diabetes (2011) Retrieved Oct. 28, 2016 from http://www.diabetes.ca/publications-newsletters/advocacy-reports/out-of-pocket-costs-for-canadians-with-diabetes

Zoe Lysy, Gillian L. Booth, Baiju R. Shah, Peter C. Austin, Jin Luo, Lorraine L. Lipscombe. The impact of income on the incidence of diabetes: A population-based study. Diabetes Res Clin Pract. 2013 Mar;99(3):372-9. doi: 10.1016/j.diabres.2012.12.005.

Booth, G. L., Bishara, P., Lipscombe, L. L., Shah, B. R., Feig, D. S., Bhattacharyya, O., & Bierman, A. S. (2012). Universal drug coverage and socioeconomic disparities in major diabetes outcomes. Diabetes Care, 35(11), 2257–2264. doi.org/10.2337/dc12-0364

Booth, G.L., Hux, J.E. (2003). Relationship between avoidable hospitalizations for diabetes mellitus and income level. Archives of Internal Medicine, 163(1):101-6. doi:10.1001/archinte.163.1.101