Yesterday, the Fed Government announced a new $430m policy aimed at reducing diabetic admissions in hospitals. Nationally, diabetic admissions account for around 32% of all 'avoidable' hospital admissions. The idea is that if this number is reduced, then the pressure on the hospital system will also decrease. Also check the Govt press release.
The new policy provides financial incentives for GPs to prepare personal care programs with their patients, with extra bonuses for GP Practices which can demonstrate an improvement in their patient's health. GPs can collect $1,200 every year for each diabetic they treat, while the practice can receive an injection of $10,800 for improvements to patient health.
For those of us with type 1 diabetes around the country, I think we all came to the exact same response: WTF?!
What an utter waste of money and a total missed opportunity to actually try to improve the health outcomes of people living with diabetes. Both types.
A General Practitioner does not have the credentials, nor the time to acquire these credentials, to know how to manage a person with diabetes properly. GPs must have a generalist knowledge of all health things. They are (and I quote a GP on this) 'expert bullshit artists'. Trying to get them to know how to diagnose diabetes in the first place is already a big enough challenge. We still hear of stories of misdiagnosis and lack of basic care such as joining the dots on symptoms and performing a spot blood glucose test. And now there is an expectation that they can manage day-to-day needs of all types of diabetics? Seriously?
How about $430 million towards:
1) increasing the number of endocrinologists (and up to speed diabetes educators) across Australia and in rural areas. These guys specialize in diabetes. This is what they do all day. Provide more incentives for new ones to emerge and to establish in areas where the supply is low (such as Canberra and rural areas such as Sale and far east Gippsland). And make sure everyone (endos and diabetes educators alike) knows what products are out there and how to use them! Provide subsidies if possible. The biggest problem with the slow uptake of insulin pumps in this country (which have been subsidised since 2004) is NOT because of the diabetics - it is because of the lack of education and poor pro-activeness of the endocrinologists and diabetes educators. I have a friend who I gave my spare insulin pump to THREE years ago, and his endo still does not think he is ready to use a pump. What a slackarse, shithouse supporter of good self-management. If these guys aren't getting diabetics onto the good stuff that is out there, how the hell can GPs do it?!
2) subsidising tools that will actually make a difference to a person living with diabetes. Which requires a change in legislation to achieve. How about we throw a tiny proportion of the $430m towards getting a fair outcome for everyone with providing the latest technology that is out there? The only way we can do this is to get the Fed Minister for Health to pro-actively change the subsidisation setup to support the new technologies that are currently available. Continuous Glucose Monitors and new pumps such as the OmniPod are currently approved for use in Australia, but no one is selling them because they are not subsidised. Access to the latest technology (and the promotion and support services for these technologies) greatly improves diabetes management. Seriously. I can't believe you dicks didn't think of something so obvious to help the lives of people with diabetes. Check the available evidence!
And again, when you do subsidise it - provide incentives for endocrinologists and diabetes educators to get their patients to use it!
3) get education linked to subsidies. DAFNE (Dose Adjustment for Normal Eating) and FLEX IT (Flexible Insulin Therapy) courses provide people with diabetes excellent opportunities to bring their diabetes management up to speed - and have great results (again, check for evidence on these practices in place for over 20 years in some countries). Get everyone through these courses. Pay them, bribe them, link their diabetes subsidies (NDSS) to them - whatever it takes to bring everyone's education up to speed.
4) make an acknowledgement that PEOPLE WITH DIABETES KNOW MORE ABOUT THEIR CONDITION THAN ANYONE ELSE. And a shitload more than the average GP. Yeah sometimes shit happens and you end up in hospital. Like attending a hens day and falling asleep with your pump removed and waking up in the morning throwing up for half a day before realising that it isn't from being hungover...
If you empower those living with the actual condition, I guarantee that you will see less hospital admissions.
A lot better than throwing $430 million down the drain.
What a total, utter waste of money.
Diabetes Australia should be ashamed for supporting such an ill-thought out policy.
Monique Hanley
One angry diabetic.
5 comments:
Very interesting! It sounds like there was little analysis done on how and why those diabetics ended up in the hospital.
That plan sounds so crazy, it sounds American! lol!
Thank you for the insight into how other countries handle diabetes! If I ever figure out what this new health care bill in the US means for diabetics I'll post my best explanation as well. :)
It sounds like much of the Australian government's policy is aimed at T2's -- much as it is in the US. Unless one is on insulin, one generally is NOT referred to an endo for T2DM (and no, the GP's are not any better qualified to treat T2DM here than in Australia). Those of us who are best able to care for ourselves are those of us who are willing and able to do our own research, to separate truth from fiction (whether that be from "snake oil salesmen" or Big Pharma or the big Diabetes Awareness agencies), and take ownership of our health above and beyond what any person with a state license would advise us.
Subsidies created preferred classes of treatments which, as you may have noticed, do not progress as quickly as a free market might. (This is why I fear for the future of healthcare under "Obamacare".) True, not every PWD will be able to afford a pump and CGM -- but each will choose his care regimen based on his own research and his own pocket (and hopefully with the guidance and support of a fully-informed medical team that is not constrained by politics).
Another thing to consider is that whenever a good or service is socialized and subsidized, its monetary cost rises out of proportion to its social benefit, until its growth becomes unsustainable. At that point, the good or service gets rationed by one or more government policies. In order to provide the most care for the greatest majority of the population, one must disallow the disproportionate consumption of that good or service by the minority. In the case of health care, the minority is the chronically ill, the elderly, those with certain classes of developmental disabilities...
Rather than risk popular wrath and international sanctions by killing us off directly, the government can disallow us the disproportionate service we need and cause us to perish "of the natural progression of our diseases".
I hope you've done more with your response to yet another f^cked up govt expenditure plan than leave it here, Monique. It's gotta go where it may have true impact and maaaaybe change some of those life-threatening outcomes that currently won't change under this proposal.
Good luck!
Lawrence
Great article Mon, I think you need to move on to some policy-making area of state and federal government health departments or else more decisions on the run will continue. You don't hold back wilh the language either I noticed!! JH
good article Monique! tidy it up and send it through to the Health Minister, Kevin Rudd, Diabetes Australia etc etc. too many good points are raised not to send it on to those who can make a difference. xxmumxx
Post a Comment