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The Question: What are the best and worst places to have diabetes in Canada, based on the cost of needles and other supplies?
The Answer: This question came via twitter from a patient, who rightly pointed out that health care in Canada isn’t always fully covered, especially when it comes to having a chronic condition such as diabetes.
Out-of-pocket costs for patients with Type 2 diabetes, the most common form of the disease, were lowest per year for those living in Nunavut and the Northwest Territories, where it is fully covered. In the Yukon, there is a $250 deductible, then full coverage.
The next lowest provinces are Quebec ($1,546.58) and Saskatchewan ($1,870.50). The highest costs were encountered in New Brunswick ($3,426.99), Newfoundland and Labrador ($3,396.04) and Prince Edward Island ($3036.31). Ontario ($2,073.50) was considered a middle performer. That compares to the Canadian average ($1,824.97), according to June 2011 data provided by the Canadian Diabetes Association. Those figures are based on payments made by those with an annual individual income of $30,000. In many cases, the out-of-pocket increases for those with the higher incomes of $43,000 and $75,000, save for the Yukon, New Brunswick and Newfoundland and Labrador, where the amounts are the same, no matter the income.
The amounts are based on case studies and include the cost for medications, devices, test strips for glucometers and other supplies – items that are not typically covered on public health plans.
Though the Canadian Diabetes Association’s method on tracking costs is limited – it cannot be generalized to the overall population – it is the best information currently available on cost by province.
An estimated 2.4 million Canadians were living with diabetes in 2008-2009, according to a Public Health Agency of Canada report published in 2011. Data obtained from blood samples suggest about one out of five cases of diabetes remains undiagnosed, according to that same report.
Those with type 2 diabetes have high levels of glucose in the blood. If left unmanaged, there is an increased risk of developing long-term complications such as cardiovascular and kidney disease.
Leigh Caplan, a diabetes nurse educator at Sunnybrook, often sees patients who manage with struggling with the financial burden associated with their condition. Not only do they need to make a series of lifestyle changes but also these individuals often must deal with the extra costs.
“Managing a chronic condition involving lifestyle and behavioral changes is challenging enough,” said Ms. Caplan, who sees patients with diabetes ranging in age from 20 to 90. “Adding in extra costs, just adds to the stress.”
The cost of test strips ranges from $1 to $4 per day, depending on how often an individual tests their blood sugar.
In some cases, Ms. Caplan can suggest individuals test their blood sugar less often and at varied times to help reduce the use of test strips without compromising patient care.
“There are other hidden costs as well,” said Ms. Caplan, noting that those with diabetes often have to take other medications to lower their cholesterol and blood pressure. For example, many of these medications are not covered, except by third party insurance or if a patient is aged 65 or older.
So while the out of pocket costs are higher in the east coast provinces of New Brunswick, Newfoundland and Labrado, and Prince Edward Island, there are ways to keep expenses down.
For further background visit the Canadian Diabetes Association’s website.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.