Tuesday, August 02, 2011

It requires a lot of time and effort....

Denmark has very high tax rates - don't know if they're still the highest in the world or if the current government's tax stop has changed that. Our high taxes pay for free education, unless you choose private schools, free medical care (there are some exemptions here as well) and many other services for the benefit of the population.

Diabetes is no cheep acquaintance. Living in Denmark, and for the past few years also in Scotland, however has kept the costs of insulin, pump supplies and test materials low for me. In Scotland, NHS made sure that I got all my insulin and test supplies for free. In Denmark, the hospital I attend pays for my pump, its supplies (except personal pump accessories of course) and the CGM sensors that I may need to use. Insulin is not free of cost. It used to be, but years ago the rules were changed so that we've now got a central subsidy scheme where prescription only medication is subsidised by different rates. If your medicine costs less than 865 kr (approximately $160), you pay the full price, but above that you get 50% subsidised up to 1,410 kr (approximately $265), then 75% for costs between 1,410 kr and 3,045 kr (approximately $265-570), and for everything above the 3,045 kr mark you get 85% of the costs covered. There are different rates for children, but there is still something to pay. For every person, the subsidy scheme is reset 1 year after the first transaction. With the different meds I use, I generally spent most of each "subsidy year" at the higher subsidy rates, but I still find this system sub-optimal. Especially when I was a student, it meant a lot whether I had to pay 1,500 kr (approximately $282) or 15 kr (less than $3) for my medication. Now that I'm employed, I'm better able to cope with these greatly varying medical expenses. I know that this type of system is probably far easier to administrate so that most people can benefit from it, regardless how dependent they are of prescription only meds, but while the average monthly cost for me and other chronically ill people in general is affordable, it is a killer that in reality the costs are so unevenly distributed.

Coverage of test strips, lancets, meters, pen needles and syringes etc. have long been regulated, though mainly for type 2 PWDs, and the regulations have varied from council to council around the country. Most places, type 1 PWDs have access to unlimited amounts of test materials free of charge, while type 2 PWDs can only get a certain number (I believe it's some 150 test strips/month, but am not sure). Some councils have had restrictions on where you could get the supplies (i.e. pharmacy or private vendors), but for most parts you'd still have unlimited choice of products. This is now changing - at least where I happen to live. A couple of months ago I received a call from a representative of Danish diabetics asking me if I had any issues getting the test supplies and needles that I wanted now that my council had made a deal with a private vendor about the delivery of these products. I was rather uncomprehending as the council had used this vendor for years already, and I had never had any issues in the past. Mid-June, however, I received a message from the council that they had indeed made a new deal with said vendor, valid from March of this year and 3 years ahead, and that from now on only certain items would be covered. When I looked through the list of items now covered, I was surprised to see that most of the test strips that I use were no longer covered, especially as I had received my latest order in April and had not had to pay anything.

Annoyed and a bit confused I phoned the municipality services to inquire about this. I was told that the council had decided upon the selection of meters, test strips and lancets based on what was most often ordered. I was still puzzled by this answer, as I know that I order about 1,200 test strips every year for my main meter. These strips are included in the current deal, however only in 50 strips packages and not the 100 strips packages that I normally order. The response was that the pack size had been chosen to accomodate the restrictions on number of test strips covered for type 2 PWDs. Hmm, I guess I can live with this - twice the number of test strip cassettes will obviously take up more space in my closet, but it's the council who'll have to pay more for the higher number of 50 strips packs than for less 100 strips packs. What bothers me more is the fact that the selection of meters included in the deal is so narrow, and doesn't contain a single of the small, handy meeters. Most of the meters on the list are rather big/heavy, their main feature being big displays. Two of the meters that I use are on the list - my primary meter and a newer all-in-one solution that I find some use of when on the move where a single-hand operated device generating no waste is nice. The latter meter, however will probably never be my favourite due to its size and weight (it almost resembles a late 1980'es cell phone by size and weight). I'm of course pleased to find my primary meter on the list, but also greatly saddened to see that the FreeStyle Lite meter that I keep on my night stand for middle of the night/first thing in the morning tests is not. To my knowledge, the FreeStyle meters are the only ones (available to Danish PWDs) with a test strip light, which is why I heart this meter by my bed. I don't have to get up to turn on the light when I feel queasy from a middle of the night low, and most important, I can perform the test immediately instead of having to wait until my eyes have grown accustomed to the light, thus also making it much easier for me to go back to sleep afterwards. I don't even want to think about how little sleep I might get when having to deal with basal rate tests without a meter that I can use in the dark!

Poking my fingers up to 15 times a day (when I'm not wearing a sensor), I have carefully chosen the lancets that I prefer, not to mention the lancing device. None of them are on the current list. It's not that I need to renew my lancing device that often, and it isn't even that expensive, but it bothers me that I can now only choose from thicker lancets than the ones I currently use, unless I pay for them myself. My fingertips definitely tells me that there's a huge difference between using lancets of 30G (a selection of which, as well as some 28G, are available from the current list) and the 33G ones that I've used ever since they came out. In Scotland I had the "pleasure" of getting the same brand of lancets in 30G instead of 33G once, and it was a painful month to get through, leaving numerous black dots on my otherwise dot-free fingertips!

My phone call to the council assured me that of course I could continue to order the supplies I wanted, but that I would be billed for those not included in the current deal. While promising myself that I wouldn't leave this without a fight, I accepted this message. Today I had to order new supplies and as usual I logged in to the vendor's web shop for this. My order contained both supplies included in the deal, a lot that are not, and some glucose gel. The glucose gel and other non-medical consumables (food, books, batteries, etc.) are usually paid for during the check-out process, and I had been told that billing for the supplies not included in the deal would be handled separately, so I just proceeded to check-out to pay for my gel. However, I wasn't able to proceed, just got an error message that I couldn't continue while running "Navision Application Server". I didn't really know what to make of that so I had to call their customer service, and was then told that this was because my order contained items not covered by my council's deal with the vendor, and that the vendor just had not yet managed to set up the online ordering system to deal with such orders! Sheesh!!!! I then had to give my order by phone, and time and time again assure the customer service assistant that, yes, I knew that I'd have to pay for part of my order, and indeed I would do so as well as fight the council separately.

Now I need to gather information about the legislation on this area to see what my options for arguing the council's decision are. My current order will cost me 1,700 kr ($320), and will probably last me for a couple of months, so if I have to pay for everything in the future, I need to revise my budget to include these significant additional expenses. Don't get me wrong, I don't see it as an obligation for everybody else to pay for my medical expenses, but I do find it wrong that I'm charged such high taxes without then being able to choose what I want these tax money spend on. If I and other PWDs pose too high costs for the council then I'd rather the council limit the total amount they'd be willing to pay for my D supplies than having them try to force me to use "medieval" remedies. I know it's all about budget cuts, and that some will probably see me and other Danes as spoiled kids when we complain about these types of restrictions, but it's probably because they have never been used to a tax-financed health care system, or if they have, then have never had to make as much use of it as chronically ill people have. In a country with high tax rates nobody will make equal use of all the services paid for over the taxes, it's a joint club and those who have no need for medical aids may have a host of school-aged kids who get free education, or spend hours every day on the roads and bridges that are also partly or fully financed by taxes.

It does indeed require a significant amount of time and effort to cope with the challenges presented to us in consequence of diabetes - especially when we don't only have to fight our own body but also municipal decisions affecting our health.

1 comment:

Pearlsa said...

The new system sounds a bit like ours with pharma being separate from medical.

Let us know how the fight goes