A new report was released today by the Australian Institute of Health and Welfare. Insulin Pump Use in Australia provides a snapshot of pump use and how it has changed in the past few years. You can read the press release for selected highlights. For more info and to bore your friends senseless, read the whole report.
This is an important report because not only does it show how we are tracking with the use of this technology, it also gives insight into barriers to taking up this therapy.
Right now, about 10 per cent of people with type 1 diabetes are using an insulin pump. That’s an increase of over 30 per cent since 2004, which was when the NDSS pump consumables subsidy was introduced. Also, more people are starting to use a pump within two years of diagnosis. It will be interesting to see the impact of that over the next 10 or so years.
You all know that I am a huge pump advocate. I was one of the early adopters of this technology, and have now been pumping for eleven-and-a-half years. I couldn’t imagine not having access to this therapy, but the reality is that for a considerable number of people pump therapy remains out of reach. And really, that’s not okay.
Access is a buzz word in healthcare and how it refers to pump therapy is twofold. Of course it refers to cost, but it also is relevant when we are talking about workforce. There are simply not enough health professionals out there to keep up with demand. This is evident in waiting lists, health professionals’ refusals to put people on pumps and the lack of follow-up. The report states that:
In spite of recommendations for contact with a health professional every 3-6 months, 10 per cent of insulin pump users had not had contact with a professional in over 6 months.
The increased initial and ongoing costs associated with insulin pump use are reflected in the socioeconomic profile of users. About 70 per cent of pump users live in areas classified into the middle to high socioeconomic status groups.
An insulin pump costs between $4000 and $9000 (ongoing costs not included). For those with private health insurance, this cost should be covered. According to yesterday’s report, about 80 per cent of pump users received a rebate for the purchase of their pump from their private health insurer.
A small number were able to access the highly inefficient pump subsidy program administered by JDRF. This grant is only for those under 18 years and is means tested. Up to 80 per cent of the pump cost can be subsidised, provided the individual meets the criteria. I have always been critical of this program. Why is it only available to children and adolescents? Surely needs extend far beyond age? Women planning pregnancy are encouraged to aim for optimal BGL levels, which may be easier to achieve using a pump; those experiencing impaired hypo awareness may find an insulin pump assists with regaining hypo symptoms; those who have experienced severe hypos may find that the use of a pump with CGMS can reduce the severity of their hypos.
Ongoing costs are also a factor for some people. The report states that the ongoing cost of using a pump is about $29 a month, compared with about $7 per month for those on MDI. This cost is difficult for some to manage, with 32 per cent of survey recipients stating that pump consumables were too expensive. In fact, this cost was cited as the biggest issue when it comes to pump therapy.
Remoteness also refers to geography, with 70 per cent of users living in major cities. This surely reflects the difficulties faced by people in regional and remote areas when it comes to finding suitably qualified health professionals. With most pump clinics being located in major metro teaching hospitals, there is an added degree of difficulty for people living outside these areas when it comes to accessing pump information and therapy.
It’s not good enough. When did having access to medical technology become a luxury?
We pride ourselves on having a health system that is accessible to all and I am the first person to be grateful and thankful for our public health system, Medicare and, for those of us living the diabetes dream, the NDSS. I have followed closely the ‘Obama-Care’ debate that is going on in the US and have spoken with many people with diabetes living over there and I know that things here could be worse. Much, much worse.
But that doesn’t mean that we don’t need to address the short-comings of which there are many. This report highlights where pump therapy is on the Australian diabetes healthcare landscape. But it also shows where we could be doing better.
Renza Scibilia is the Manager of Type 1 Diabetes and Community Programs at DA–Vic. She has lived with type 1 diabetes since 1998. The opinions and thoughts expressed in her occasional blogs are her own.
Thinking of taking the pump plunge? We’ve got lots of information on our website.