Wednesday, April 6, 2011

What about us - it isnt fair!!

Joining the DOC (Diabetes online community) has been a bit of an eye opener for me.   With Reuben coming up to one year with type 1 diabetes we havent met too many PWD or D-rents with CWD.   The ones we have met have been awesome however.   Being online, I quickly saw that the technology used overseas isnt whats available here in Australia, and to my way of thinking should be !

I am by no means resistent to getting Reuben on an insulin pump Im not sure if anyone had that impression or not, infact ever since diagnosis we've been looking into this.   MDI is what our hospital automatically trains you to use, and assume you will go along this path until you can afford a pump or need to change your insulin therapy to get better control.   Things are set up differently here, as Im sure the health systems in UK, US,NEW ZEALAND, CANADA and various other places are.

Where do I start?   We pay taxes that contribute towards a national health service called Medicare.  Over time different governments have tweaked it, stuffed around with it and various other shananigans (?) lol.    So if we have to see a general practicioner, (GP)   we can do what you call bulk bill - no money up front, and the government pays the service provider on your behalf.   These surgeries are busy, have huge waits, (massive overgeneralisation I know, this is just my opinion) and usually understaffed!  Hospitals are the same deal.   You can go in and get seen on Medicare, and not pay up front. But you gotta wait! )     If you walk into the dr's surgery down the road, they may ask for the full amount up front, and not offer 'bulk billing'. This is confusing since some do, some dont.... Because you have to pay, they never seem as busy.    Some of this money can be claimed back on medicare, but usually you are out of pocket upwards from $30 for the consultation.  

Then theres a PBS, pharmaceutical benefits scheme.  Again, some drugs are on this list for subsidy, some arent.   Insulin is on it, thank goodness, you foot a bill of around $30 from memory for $90 worth of insulin.   Thats pen fills for 5x5.  Weve yet to use up a full script.  Glucagon, only a few dollars, down from $50!

When it comes to diabetes care,  we have a National Diabetes Services Scheme.  The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. The NDSS delivers diabetes-related products at subsidised prices and provides information and support services to people with diabetes.   So our pen needle tops and syringes are free.   Testing strips are subsidised so a box of 100 strips, instead of costing $50, is only around $3.  More expensive items are glucose monitors, lancets and ketone strips, imo, should be heavily subsidised too as they are essential to diabetes care.    If you want you can go to a bulk billed diabetes centre (which you get an indefinate referral towards) and so nothing comes out of pocket for this either.    

(Please correct me if Im wrong or any detail is innacurate or over simplified!)

You can opt to contribute to a private health insurer to get medical extras partially contributed towards VIA them, if they feel like it.  (nudge nudge)   An example is dental work, you pay a premium month to month, and when you go in get the work done, you pay for around 50% and the health fund pays the remainder.  (Duh, we know who comes out in front on this one!)   

So physiotheraphy, podiatry, dental, optical, that sort of thing is covered under an 'extras' policy.    If you want an insulin pump you have to either pay out of pocket around $10,000 intial outlay or  if you hold private hospital cover and contribute for a year waiting period you can get this paid for under a clause in your contract that says they cover 'surgically implanted prosthesis' as a result of a hospital stay.  (Its on the prosthesis list, via Australian Government, Department of Health and Ageing, see below an excerpt to show whats payable by private health insurer and the list of available pumps).   This is only done every 4 yrs , I guess thats when the pumps warranty is up?  

*** if you dont have private health cover contact JDRF. You may be eligible for a one off payment of up to $6,400 (means tested I think) to help towards the cost of a pump through the Juvenile Diabetes Research Foundation - click below!

JDRF


Pump starts require a bit of jumping through hoops and rightly so, I guess they'd be dangerous in the hands of the untrained.    Theres seminars, nurtition and carb counting sessions and the a w a i t i n g list a few months long.    For us personally, theres also the issue of my husband getting additional time off work to be home and learn to operate the pump as efficiently as myself. 

One of my own big gripes is CGM, theres no selection.  The sensors and its unaffordability to the average person and family living with diabetes is insane...  $70 for a 3 day site (if it lasts that long).     I emailed Closing the Loop, they are trying to bring both the Omnipod tubeless insulin pump and dexcom Continuous glucose monitor to Australia.  See their response -

The voice of those people wanting the Omnipod in Australia has not been loud enough





While many have joined the 400 people who have signed the online Omnipod petition http://www.gopetition.com/petitions/omnipod-in-australia/signatures.html and many have written letters, this it would seem is not enough to convince the Federal Government and Diabetes Organisations that the Omnipod would be of value in Australia.   While this is very disappointing for us, we fear this may also have implications for many other new diabetes technologies in Australia. 

Recent delays and decisions by the Department of Health, delays in supply and lack of support for policy changes from JDRF or Diabetes Australia have caused us to rethink Omnipod in Australia and how we best go about achieving equivalent funding in Australia. We have now been in discussions with the authorities since 2008 and still have not achieved equal funding to what is provided to our competitors.

We have now decided to seek investors who are interested in assisting us build a case for equal funding for the Omnipod in Australia.        

Should you know of anyone who may be interested in investing in CTL to help us achieve equal reimbursement, please have them contact us.





Dexcom will not be available until at least next year in Australia.

We thanks you for your ongoing interest in our products.

Regards

John Douglas
 ***************
Basically friends, spread the word!!    So now Ive waffled on for a bit, in summary, if we go get an insulin pump once our one year private health fund waiting period is up,  its a 4 year committment to a pump, at which time Reuben will be a 6 year old boy before we qualify for an upgrade!   I dont want to rush into
things, who knows what will happen!?


***************
APPENDIX- Surgically implanted prothesis list - you see theres a few pumps to choose from, none of them tubeless.
**
3.2.2.2.1 External Infusion Pump, Battery powered, Insulin, Generation 1
Managing Diabetes Pty Ltd
DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00
Roche Diagnostics Australia Pty Ltd
RO020 Accu-chek Spirit Insulin Pump Insulin infusion pump One size only $4,000.00 $5,000.00
3.2.2.2.2 External Infusion Pump, Battery powered, Insulin, Generation 2
Australasian Medical & Scientific Ltd
AN005 Animas 2020 Insulin Pump. Ambulatory Insulin Infusion Pump 7.4cm x 5cm x 1.9cm $7,750.00
Roche Diagnostics Australia Pty Ltd
RO001 "Disetronic Insulin Infusion Pump
System"
D-Tron plus Large Kit Blue or Anthracite $6,700.00
RO009 "Disetronic Insulin Infusion Pump
System"
D-Tron plus Small Kit Blue or Grey $6,400.00
3.2.2.2.3 External Infusion Pump, Battery powered, Insulin, Generation 3
Medical Specialties Australia Pty Ltd
MS031 Medical Specialties "Deltec Cozmo
Insulin Pump"
Ambulatory Insulin Infusion Pump Deltec Cozmo Insulin
Pump - each
$8,000.00 $9,360.00
Medtronic Australasia Pty Ltd
MC351 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Model MMT - 715 Pump Dimensions: 5.1 x 9.4
x 2.0cm
$8,000.00
MC352 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Model MMT - 515 Pump Dimensions: 5.1 x 7.6
x 2.0cm
$8,000.00
Managing Diabetes Pty Ltd
DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small
device about the size of a pager. It
holds up to 300 units of insulin, which
is delivered continuously through a
small tube to the patient. The DANAR
Insulin Pump also has an integrated
blood glucose meter and remote control
via bluetooth communication.
75 x 45 x 19mm, 60grams $5,100.00
Medtronic Australasia Pty Ltd
MC353 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Model MMT-722. 'Smart'
Insulin Pump with REAL-Time
continuous glucose monitoring
capability and with remote control
Pump dimensions: 5.1 x 9.4
x 2.0cm
$8,000.00 $8,950.00
MC354 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Model MMT-522. 'Smart'
Insulin Pump with REAL-Time
continuous glucose monitoring
capability and with remote control
Pump Dimensions: 5.1 x 7.6
x 2.0cm
$8,000.00 $8,950.00
MC839 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Veo Model MMT-554.
'Smart' Insulin Pump with REAL-Time
continuous glucose monitoring
capability, incorporating a low glucose
suspend and with remote control.
5.1 x 7.6 x 2.0cm $8,000.00 $9,500.00
MC840 Medtronic MiniMed Insulin Infusion
Pump
Paradigm Veo Model MMT-754.
'Smart' Insulin Pump with REAL-Time
continuous glucose monitoring
capability, incorporating a low glucose
suspend and with remote control.

  

7 comments:

  1. Oh my gosh. Despite what people say about our health system -- and admittedly it has some problems -- I still think we Americans are much luckier than we realize! (And, I must say, I very much prefer the government not take it over or we might not have access to OmniPods or Dexcoms either!) I hope Austrailia can get some of this newer technology soon. It seems unfortunate that everyone can't have what we have here. At least you'll be able to pump soon!

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  2. It is eye opener for me as well. Thank you so much for providing information about healthy life for diabetes patient.
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  3. I'm so sorry to hear that this is the case in Australia. I know from experience how hard it is to keep a baby's blood sugars in a tight range, which is why we begged (yes, even here sometimes we have to beg) our endocrinologist to get Andy on a pump. We were struggling with trying to give him .5 units of insulin and sometimes that would even send him too low. Personally I think pump should be a given in such a young child because their insulin needs are often so small that it is hard to measure correctly. OK, that's my input. Hope you get to pump soon.

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  4. GeezLouise.

    Seriously....it all makes me delirious.

    We made some MAJOR sacrifices for the health insurance we have. It's a really good policy, but it's come at a really high price. Worth every cent and sacrifice, but I just wish it was easier all around.

    Love our pump (Animas) and I pray you'll be able to access the technology you're interested in!!!!

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  5. Wow. Great post! I agree with everyone else. I have said this on a post of my own at one point. As expensive as our insurance is here in the u.s. (and it is soooo expensive) at least we are able to but things like pumps and such and get coverage. I think the average person would rather the "free" healthcare of other countries, but when you need so much, like a diabetic, I think we can all agree that we don't mind paying a little for the things that are important. In the u.s. It is all about getting a "good" plan. If you have a "bad" plan, you will be paying waaaay more. Great post!

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  6. Hi! My five-year-old is type 1. We live in Minnesota and pay 17,000 dollars a year for health care costs and only have basic MDI and a glucose meter. Affording a pump or CGM is something we dare not even wish for...we'd have to move into a tent! Good luck with your situation! :)

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  7. Thanks for explaining. In NZ it's different. I dont think medical insurance pays for pumps here. Most people pay themselves and some get grants.

    E has MDIs. We get free medical visits at the hospital every quarter and our insulin and supplies are subsidised by Pharmac the govt funded agency that looks after medicines. We pay about $15 per quarter (hugely subsidised) for all E's insulin, glucagon, test strips, syringes, pen needles. The hospital has given me 3 Optium Exceed meters, finger prickers (a choice of 2-3 brands) and the insulin pens. They will happily provide replacements for free. I have to pay for the lancing devices for the finger prickers (about $20 for 17)and batteries and finger wipes (which I guess are optional but seen by E as essential). I've never had to pay to see our GP about E's diabetes because our 3 monthly hospital visits cover that and I can phone the hospital diabetes team if I need more help.

    I think we are lucky in NZ.

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