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Tuesday, February 11, 2014

Investing in Future Deficits - A study on the Costs of Treating Patients with Diabetes Mellitus


Press Release

Investing in Future Deficits
A study on the Costs of Treating Patients with Diabetes Mellitus

The Metropolitan Community Clinic at Helliniko has made a study of patients suffering from diabetes mellitus which will be submitted to the Ministry of Health in the next few days.  What it shows very clearly is that if uninsured diabetics remain excluded from primary health care now, (which they still are under the new health plan) the cost to the state will be significantly more later.  We, as a volunteer clinic, find it impossible to calculate the cost to society and to the medical profession.  But we can however prove beyond doubt that by insisting on their present policy of not treating the uninsured the state is heading towards a big deficit in the future – even while proclaiming that they are doing their best for the country’s economy.

What the Ministry should have done instead of referring to “accounting” and “numbers” we did for them in this small study – which proves unequivocally that to include the uninsured in our public health system is not only more humane, but economically is in our interest.  These people are excluded from the public health system because there have been no studies on the costs of excluding them.  So the insistence on excluding these people from public health can be only one of two things:  incompetence or some other hidden reason.   

Study of the Uninsured Patients with Diabetes Mellitus

-                Patients with Diabetes Mellitus have a double mortality rate when compared to the rest of the population
-                Diabetes is the 8th most fatal illness in countries with a high GDP and the 10th in countries with a medium or low GDP
-                The lack of well organized primary and secondary health services in Greece, the great number of patients who have no access to the little there is, and the very limited system of having patients referred to specialized centers – all this leads to poor and insufficient care and treatment of these patients and to dangers complications of this disease.
-                50% of diabetics are already suffering from cardiovascular complications which will surely deteriorate with time.
-                Deterioration and complications are directly related to the proper treatment of the disease in its early stages.
-                6% of the population in Greece as been afflicted by diabetes.  So Greece, with a population of 11 million, has 660,000 such patients.
-                30% of the population - that is 3,300,000 individuals are uninsured.  That means that, here in Greece, 198,000 have diabetes and are uninsured.
-                20% of diabetics are treated with insulin, so 40,000 of uninsured diabetics are on insulin therapy.  


Yearly Cost of Medication per Patient for the Control of Diabetes with Daily Medication

Diabetes Medication
Dosage
Price per package
Number of packages per month
Cost per month
Cost per year






Soloza 2
1X1
€6.64
1
€6.64

Glucophage 850
1X2
€2.16
2
€4.32











€10.96
131.52
 Annual cost for medication per patient for the control of diabetes mellitus with daily medication

Average monthly cost of medication is 10.96 €.  Annual cost per patient = 131.52 €

170,000 patients X 131.52 € = 22,358,400 €.  If the amount paid by the patient is deducted (10%) the state will spend 20,122,000 €

Average Monthly costs for insulin is 50 €.  Cost per year per patient = 600 €

40,000 patients X 600 = 24,000,000 € yearly cost per patient receiving insulin therapy.  If the amount paid by the patient is deducted (10%) the state will spend 21,600,000 €

Cost for Glycosylated hemoglobin test: 5 € every 3 months per patient = 20 € x 198,000 = 3,960,000 €

Cost for test strips: 25 € for 2 months. 150 € per patient per year x 198,000 = 29,700,000 €

Yearly cost of Medication for the Control of Diabetes for Uninsured Diabetics

The majority of uninsured diabetics will use medication to control their condition, with an annual cost of 41.722.560 €.

Total cost: 41,722,560 +3,960,000+29,700,000 = 75,382,560 €

Cost of Hospitalization of Uninsured Patients with Diabetes Mellitus
                                                                                      
60% of diabetic patients, especially if their condition is severe or uncontrolled, will be hospitalized with at least one of the following complications of diabetes, with an average cost of 2,683


Condition/Operation
Cost of Hospitalization


Diabetic Neuropathy
1,500


Coronary Bypass
7,500
(5,000-10,000)


Stent
1,531


Cellulite
1,621


Renal failure
2,934


Septicaemia
2,514


Amputation
3,600


Infections (moderate severity)
1,400


Acute myocardial infarction (heart attack)
2,000


Ulcerated Skin-circulatory problems
2,233


Total
26,833


Average Cost
2,683




 The cost of hospitalization for the uninsured will reach:

198.000 x 60% = 118.800 x 2.683 €= 318.740.400 €

Uninsured
60%
Average Hospitalization Cost
Total Cost
198,000
118,000
2,68.€
318,740,400 €

Conversely, if patient’s diabetes is properly controlled, then only 25% of them will be admitted to hospital with complications, and cost of hospitalization is significantly reduced:

198,000 x 25% = 49,500 patients x 2,683 € average hospital cost = 132,808,500 €

Uninsured
25%
Average Hospitalization Cost
Total Cost
198,000
49,500
2,68.€
132,808,500 €

In other words, the savings realized would be

            318,740,400 € - 132,808,500 € = 185,931,900 €

Conclusion

Because the hospital must accept patients in need, hospitalization costs will pass to the tax authorities.  But the state will never recover these expenses, given that the patients have no way to pay their debt.  If the government were to include uninsured patients with diabetes mellitus into the Public Health System, it will save the state 185,931,900 €.

If from this amount, we subtract the cost of necessary medications, exams, test strips, etc, it amounts to 75,382,560 €.  The total savings will be a significant 110,549,340 € per year

Therefore, total expenses to the state for patients with diabetes mellitus will reach:

132,808,500 € (expenses for hospitalization 25% of patients) + 75,382,560 € (costs for medications, treatments, tests, films) = 208,191,060 € instead of 318,740,400 € that it now costs for patients outside the system

Notes to the above:


  1. For type 1 diabetes, patient contribution is 0%.  We used the figure of 10% for all because we don’t know the number of patients that are type 1.  We believe it to be a number too small to significantly alter the result.
  2. The hospitalization costs for uncontrolled diabetics which we estimate as 218,740,400 € does not include the costs of additional hospitalization which these patients often need, a costs which will significantly increase the annual expenses of the state.
METROPOLITAN COMMUNITY CLINIC AT HELLINIKO 

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ADDRESS: Inside the old American Military Base, 200m away from the Traffic Police of the Municipality of Helleniko, next to the Cultural Center of Helleniko
Post code TK16777, Elliniko, Attiki, Greece 
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