Replies to This Discussion

Permalink Reply by JohnG on May 3, 2012 at 6:24am

If everyone in the pool is sick (TuD insurance company)...the pool would need to have close to a 100% copay or premiums higher than we could ever afford to pay. Even if the plain was non profit we still could not afford it.

I seems like you do not understand the fundamental issue, someone has to pay for it!!

 

I'm a worst case...I have spent many years as a type 1, my insurance company's has never made a dime profit off  of my premiums and now I have cancer and waiting for a organ transplant..the cost if I survive and receive the organ will be 1,000,000.00 without complications and the maintenance will be 50,000 per year until I die.

 

I have a family member with MS and her medication cost is 9,000 US per month..shes 19...30 years on this medication will cost 3,240,000  US...she is also a insurance company's worst nightmare. 

 

 

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Permalink Reply by Sai on May 3, 2012 at 10:48am

Hi John, sorry to hear about your situation. I was assuming that not everyone is sick, right now...which delays the risk of some patients. Those who require USD 100k right now, say, can take from the pool - and repay in installments(?)

One thing is for sure, we need to pool enough money, for ourselves, and for family. I wouldn't want my family to end up bankrupt after me!

Since we have made a start to the discussion, I welcome ideas of how we can mitigate the risk, costs, etc.

For organ transplant, you can actually try to go to some other country where the cost of medication would be cheaper, better facilities available and you will have a good feeling all around - that's what medical tourism is all about.

But I guess you must have given it a thought already.

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Permalink Reply by christy on May 6, 2012 at 9:24pm

All it takes is one catastrophic major illness to become an insurance companies worst nightmare, and take that and x it by several thousands of people...insurances are banking on NOT having to pay out high medical claims that is why they spread the risk out over so many people, and charge such high premioums so when those handful of people who do become stricken with a high cost medical problem...HOPEFULLY...it doesnt just financially ruin the insurance company, they can pay out those high dollar claims for the few people who have become very ill, WHILE still mainintaining care for their relatively healthy members. There are also with insurance companies fully funded plans, which the insurance company takes on the full financial risk, and self funded plans--where the employer takes on the financial risk of paying the medical claims for its employees...as u can see, either way it can be catastrophic if you have members with high dollar medical problems for either the insurance company or the employer.

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Permalink Reply by MyBustedPancreas on May 3, 2012 at 6:24am

There is no such thing as free or equitable medical care anywhere in the world. It's a misnomer. There are aspects of socialized medicine that are good (I think). To some degree, you have a guarantee that your basic medical care will be covered. At a minimum, diabetics can get access to insulin in places like Canada and the UK, which is the very basic thing that keeps us alive for the short-term. BUT, those places have limits on things like test strips and if you want a pump or CGM, you have to jump through many hoops and can be waiting for a LONG time. In addition, I know in the UK the care you are able to receive varies depending on which county you live in. I think the same thing goes for Canada (i.e., different provinces/jurisdictions have different procedures and limits).

In the U.S., if you're really poor, you qualify for Medicaid, and you can actually get decent care through Medicaid, depending on what state you live in. All diabetic supplies are covered through Medicaid. If you're old and/or disabled, you may also qualify for Medicare. Medicare also has its limitations (I know pumps aren't covered for many and CGMs are definitely not covered), but again, you'll have basic access to insulin and some testing supplies.

Now, if you're lucky enough to have a job that offers decent health insurance in the U.S., you definitely have access to some of the best medical care around. I am fortunate enough to fall into that category and I have never had an issue getting what I need (pump, CGM, insulin, supplies, etc). Yes, I do spend about $200-$300 per month out-of-pocket on co-pays and miscellaneous stuff related to diabetes, but I am VERY lucky that I can afford this.

So, I don't think there is a "best" country for medical care and diabetes. It sort of depends on what your needs are. If you're a T1, best (to me) means having guaranteed access to insulin and the latest technology that one requires to manage their BGs and stay alive and complication free. And that doesn't really exist as far as I know.

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Permalink Reply by Jen on May 3, 2012 at 7:02am

In Canada we actually have health benefits (insurance) through employers, too. So the basics are covered by the province (you're right, depending somewhat on which province you're in, though insulin and test strips and doctors and hospitals are virtually always covered), and then you can get things like pumps and even CGMs covered through employer heath benefits (same as insurance in the U.S.).

I think there are pros and cons to each system, but I am also *very* glad to live somewhere where I am not going to ever have to worry about having access to basic medical supplies and care, and still have access to "advanced" stuff like pumps through employer health benefits.

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Permalink Reply by Emmy on May 3, 2012 at 11:19pm

Insulin, test strips, syringes, needle tips are not always covered in Canada. If you are over 65, and your income is low, yes, some of its covered, (not syringes or needle tips). Some provinces cover more, mine doesn't.

If you're under 65 its not covered unless your income is really low.

Even if your income is low enough to get some assistance, you don't always recieve it, because they can claw it back.

Say you need to get a wheelchair, ramp, or van lift, or all 3, and you have to cash in some RRSPs to pay for that necessary equipment (like we had to), then your deductable goes way up, and you end up paying for almost everything yourself, even though you've already spent thousands of dollars in necessary medical expenses. The money you withdrew has been spent but they don't care. Your insulin, test strips, syringes and needle tips, blood pressure meds and other prescriptinos have to come out of your pocket, even though you don't have it.

So even if you qualify for assistence, they can claw it back when other needs arise, ignoring the fact that the money was spent on other necessities. You basically get penalyzed for having a disability.

And what if some of that expensive equipment breaks down? Tough luck Charlie.

The system here could put you in the poorhouse.

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Permalink Reply by Till on May 3, 2012 at 6:32am

It's true, healthcare is never free. I have experience in living in Germany and Belgium and you pay a considerable amount of taxes for your health insurance. It is also true, that things like a pump or a CGM are hard to come by if your diabetes is "controlled" and you are not a child.
I, however, like that I don't depend on my employer and on being employed to receive decent care. I think care for PWD is better in Germany than it is in Belgium with basically unlimited amounts of strips provided for free and only very low costs for insulin. In Belgium the amount of free strips is limited to 5 a day but you get all the insulin for free. But in both countries you can live with T1D without it being a huge financial burden.
I don't think that having an insurance just for Ds would be a good idea, as it somehow would contradict the idea of an insurance where everybody pays in but not everybody needs to use it to the same extend. That doesn't work if everybody has diabetes.

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Permalink Reply by Sai on May 3, 2012 at 10:52am

Hi MoutainCat, I appreciate your courage to be self-employed. But the question here is do you have enough money stashed up somewhere so that you wont end up at the mercy of others, government, insurance agencies?

In India, millions of people die just because they don't have access to primary medical care. Leave alone highly sophisticated diseases with tongue-twisting names.

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Permalink Reply by nel on May 4, 2012 at 11:43am

Netherland's Health Minister's recommendation : this is what is planned (in the Netherlands ) : if you miss your appointment in a Hospital setting , you will get fined .The article states as well : patients , who are no-shows cost the system yearly 300 million euro's .

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Permalink Reply by Asma on May 4, 2012 at 2:36pm

If you have a file at a government hospital here in Saudi Arabia, you have access to free healthcare. When it comes to diabetes healthcare in particular, it is no secret that a large percentage of the overall population is diabetic. So it makes sense that a great deal of the yearly health sector budget is allocated to diabetes care centers. I get lancets, blood glucose meter, strips and the whole lot. I got my pump too. And free supplies. They wouldn't supply me with sensors but every once in a while they give you one to see you're getting by. Although I know other hospitals who do give sensors to their patients. Lab work too The doctors are well qualified- from what I've sen so far. They're very tricky with pumps though, but I managed to get one. I know that there's about 100 pumpers in my clinic. All for free since its a nonprofit teaching hospital. I have an insurance too if I needed to see the doctor for pressing matters. There are no tricks or downfalls or hidden costs. The health sector in our country is indeed very generous.

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Permalink Reply by Sai on May 8, 2012 at 2:07am

Hi Asma, glad to know that the health care sector is very good in your country. It really is good to know information.

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Permalink Reply by nel on May 4, 2012 at 6:27pm

Takes some reading: a Canadian travelling for dental care to Poland ... " It used to be that tourism was driven by aspirations of seeing pyramids or drinking tequila at the swim-up bar.
But as the population in Western countries is aging, accessing health care is driving many people abroad to get what they need when they need it.
Medical tourism is a $100-billion industry this year, according to the U.S. research firm Frost & Sullivan. It estimates business will increase a further 20 per cent next year....con't :
http://www.canada.com/vancouversun/news/westcoastnews/story.html?id...

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