Forward Motion: Shortsighted Test-Strip Rationing
To save money, an Oregon health board limits test strips for a state health plan. Andy Holder worries about the human costs.
When I was first diagnosed T1 almost 9 years ago, it felt like stepping into a tornado. But I quickly clung onto one central truth of diabetes self-care: the best way to live as long as possible and avoid complications was to test…and test often!
Makes perfect sense, right? My body no longer knows how to regulate blood glucose, so I have to prick my finger multiple times a day to stay healthy. Later, I learned it was a bit more complicated than that, but still the starting point of all diabetes care remains testing. Prick finger. Drip. Read. Repeat. The basis of health for people with diabetes.
Which makes a bureaucratic decision to limit test strip access in Oregon so depressing. Earlier this year, Oregon’s Health Evidence Review Commission (OHERC) raised the ire of the diabetes community by recommending that people with Type 2 diabetes with an A1c under 8.0 should receive no test strips, and those over 8.0 should receive just 1 strip a week under the state’s health plan.
Since then, OHERC has backed off somewhat on that recommendation, but not enough. It now says that if you get diagnosed Type 2, you should be given 50 test strips and sent out the door with a pat on the back and a “Good luck.” No more test strips would be provided under the state health plan unless you were to go on medication that could cause hypoglycemia or if you were to have pronounced swings in your blood sugar. Let’s take a moment to savor the irony of that last provision. Essentially, they’re saying, “We won’t provide you test strips to help you control your A1c unless you can’t control your A1c.”
The reaction among the diabetes community to such a move has been a combination of astonishment and anger. How could anyone who knows anything about diabetes make such a decision?
The answer might be that the decision was made by people who don’t know much of anything about diabetes. If you look at the make-up of the commission members (a psychologist, a former firefighter, a dentist, two chiropractors, a family physician, and a pharmacist), you see it’s lacking anyone resembling an endocrinologist or a certified diabetes educator. That would be like me passing a law mandating safety precautions for electricians who are wiring new homes.
There actually is a method to the board’s madness, and this is not an isolated event. It’s part of state and national efforts to contain health care costs. It’s the same motive behind Medicare’s decision to open up diabetes test supplies to competitive bidding, a move that has drastically consolidated the diabetes supply market. Health care costs are skyrocketing, and health officials are trying to find ways to make sure pharmaceutical suppliers aren’t gouging consumers. I get that. I even applaud that.
But OHREC’s move is an example of cutting off your nose to spite your face. Whatever budget savings realized by restricting test strip access for those on the state plan will be more than offset by increased health care costs for people with out-of-control diabetes. Think about how many more emergency room visits, how many more hospital stays, how many more amputations will result from this policy. In the end, Oregon will be forced to pay millions of dollars in increased health care costs for this move. But the human cost will be even greater.
We in the diabetes community need to make our voices heard. Policymakers who don’t know enough about diabetes to be making these kinds of decisions need to be educated about the importance of good diabetes care, and of how much money preventive care will save. It’s believed a successful Change.org petition helped nudge the powers that be towards a more reasonable position. This shows our power. To change misguided policies like this, we need to be more than angry; we need to be active.
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