In 2009 it was reported that the United States led all OECD countries with its high rates of lower-limb amputations and acute hospitalizations related to diabetes. 2011 data show that we exceed the OECD average, age-standardized diabetes prevalence by nearly 40 percent and have the sixth highest prevalence in the 31-member group. The CDC reports that one in every three U.S. adults might have Type 1 or Type 2 diabetes by 2050. Although there are signs of encouraging progress, more should be done to improve financial and material access to care — and the process, quality and outcomes of that care — for patients who have diabetes or are at risk of developing the condition in the future.
Last summer, supported by a generous grant from Penn’s Center for Undergraduate Research and Fellowships (CURF), I toured Australia for three weeks to learn about its approach to diabetes care. Through in-depth conversations — with general practitioners, endocrinologists, nurses, diabetes educators, public health officials, hospital administrators, and policy researchers — I learned about programs and structures that might be adapted and implemented into the United States’ healthcare system, despite the surface concerns of demographic and cultural differences.
Here is a rundown of the major programs that support Australians with diabetes: the National Diabetes Services Scheme (NDSS) provides informational support and subsidized equipment for self-managed glucose testing and insulin therapy; the Pharmaceutical Benefits Scheme (PBS) provides subsidized diabetes medications with low co-payments; the Medicare Benefits Schedule (MBS), which covers Australians of all ages, provides five visits each year to allied healthcare professionals such as dieticians and diabetes educators; the Practice Incentives Program (PIP) provides general practitioners with bonuses for completing annual cycles of diabetes care for their patients.
I believe that this suite of services, to which all Australians with diabetes have access, can be provided at a subsidized or free price to all Americans with diabetes. Access to high-quality information and support groups, self-management equipment, medications, the advice of diabetes educators and podiatrists, and physician incentives to complete evidence-based care processes: these aligned systems, working for all patients with diabetes, might have a significant impact on patient health and reduce the nation’s healthcare cost burden.
This program would at least be an improvement on our current state: low-income and under-insured patients unable to afford medications and self-management equipment; complex rules that discourage access to useful allied health support services; and patients who are unable to manage their conditions until devastating complications land them in the hospital.
Over the next seven months I will research and write a senior thesis that examines the costs, obstacles and implementation strategies for this potential program. Although I am primarily looking at the potential program’s economic and health impact, I will incorporate knowledge about the role of behavior and environment on chronic disease, as well as the different experiences of patients with diabetes across cultural groups.
Even if the proposed program turns out to be too expensive and the potential health impact unclear, I think that this inquiry will be a useful learning experience and look forward to starting the journey. Feel free to reach out with comments and suggestions!
Imran Cronk 