Better to prevent than to cure
The costs of diabetes disease in Albania
This situation for the entire community that has an ongoing growth of the number without asking if is:
– Infants who can not find the courage to inject insulin.
– Children who is difficult to stop his curiosity to enjoy all food and effort you pierced your fingertips to see the rate of blood sugar.
– Adolescent, who legaly have to be employed, which is very difficult and therefore only collects stress, compassion and leigh forced to neglect the health with many consequences.
– Without forgetting the elderly, which neglect that because of the impossibility of having diabetes costs.
This situation, which is lived approximately from 7% of the population in Albania, it is difficult even for Albanian state.
If we do not prevent this disease with high costs, all as a state, society, family members and patients will have immeasurable expenses in economic costs.
In Albania there is not a register, which shows the real number of people affected by this “sweet” disease, there is not a meaningful statistic to shows how many patients are harmed by this “abrasive” and spending costs.
Diabetes is killing people with no end and without distinction of age, gender, location or economic status.
It is known that diabetes is one of the most costly diseases in the world and each day and more, he is spreading frightening and is threatens humanity.
But what is the cost that these patients face with the disease every day of their lives?
A person with diabetes need medications and materials such as: insulin, needles, lancet, chips for measuring glycemia etc., from which the reimbursement is only for insulin but this requires a very long and tedious procedure, laborious and costly, especially for patients districts.
According to doctors endocrinologist consultation, a person with diabetes should perform about 32 tests and visits a year, of which some are every 3/6 months.
All these daily intake and annual checks, always according to the recommendations of doctors reach an annual cost of 388.620 ALL per person.
The table shows the annual and monthly costs for people with diabetes according to the criteria and advice with the endocrinologist doctor.
It shows a daily consumption cost that in a month reaches 13,127 ALL.
The rest shows that a person with diabetes need to save per month, to carry out all tests on a year, a monthly amount that reaches 19.258 ALL/ month.
And totaly monthly costs goes to 32.385 ALL.
If these tests are not followed periodically, the person with diabetes will begin:
- a) Three complications are:
2-wounds in diabetes
- b) The five diseases that are:
- c) Six injuries that are:
3 brain damage
5- nerve damage
6-diabetic ulcers, that mostly passes in cutting limbs.
All these injuries, count how much money cost their operations and treatments for everyone.
And for all these, state aids with a social assistance 9.400 ALL, who interrupted when begins a job with a minimum payment or an internship school because are paid the insurance (a kind of open discrimination in this part that has an actual problem).
If we count 32 385 ALL monthly expenses, subtract 9.400 ALL and the difference that we ask ourselves where to find them results 22. 985 ALL. Without putting nutrition diabetic diet!
Getting out of control of the disease the patient starts the fight with complications such as:
- Eyes damage – diabetic retinopathy
- Heart demage – coronary artery
- Brain damage – stroke (brain) In the context of
- Kidneys damage – diabetic Nephropathy diabetic antiopathy
- Diabetic ulcer
- Nerves damage – Diabetic Neuropathy
If start these complications, the patient and the state adds another cost, is that of hospitalization. By a simple calculation of hospitalization in a public hospital for a night it goes:
8000 ALL * 3 days minim = 24,000 ALL
8000 ALL * for 5 days max = 40,000 ALL
In Table 2 we show a calculation for insulin pens. According to the age of the patient on the board, is calculated the amount of insulin pens needed by a person with diabetes.
HOW TO CALCULATE THE AMOUNT OF INSULINS PENS?
|QUANTITY UNIT IN PENS||DAY INJECTION||QUANTITY UNIT||DAILY AMOUNT UNIT||QUANTITY UNIT REQUIRED FOR 30 DAYS||QUANTITY UNIT REQUIRED FOR 365 DAYS||Insulin pens per year needed|
|QUICK INSULIN under 5 years old||300||3||5||7||5||17||510||6.205||23||Pens|
|Age 6 years – 17 years old||300||3||10||10||10||30||900||10.950||39||Pens|
|Age 18 years – 30 years old||300||3||10||15||15||40||1.200||14.600||51||Pens|
|Over the age of 31 years old||300||3||15||17||17||49||1.470||17.885||62||Pens|
|INSULIN DELAYED under 5 years old||300||1||10||10||300||3.600||14||Pens|
|Age 6 years – 17 years old||300||1||15||15||450||5.400||20||Pens|
|Age 18 years – 30 years old||300||1||20||20||600||7.200||26||Pens|
|Over the age of 31 years old||300||1||30||30||900||10.950||39||Pens|
But the difficulties begin with an increasing number of insulin for people with diabetes, especially of the districts, wandering and waiting in line, staying in Tirana city, diets which will consume and the loss of a working day if they have provided one!
– All these cost and difficulty of patient with diabetes could be avoided by dividing this abuse in the regions or continuous checks that should be made on specialist doctors and pharmacies. This control will bring goods for the patient as well as for the state, while avoiding abuses over the years with insulin and the use of these funds for reimbursement of chips and needles.
The annual cost for a person insulins:
50 pens acting quickly multiplying 1,200 ALL per year (average price) = 60,000 ALL
30 pen slow motion multiplication 1,900 ALL per year (average price) = 57,000 ALL
60.000 ALL + 57.000 + 9.000 social assistance = 126.000 ALL expenditure for a person with diabetes has the Albanian state.
But are enough only insulins for the maintenance of the diabetes disease?
Unfortunately, we must say NO, recognizing that we are conducting a useless expense!
Patients with diabetes have lack of some materials that are vital to their everyday life for the treatment of diabetes such as Lancet, jacks glycemia, needles insulin, measurement of hemoglobin glucose (HbA1c), the hormone glucagon, and the way prolonged that should follow a person with diabetes to documents added or modified insulins and kemp retirement each year.
1- Lancet: Measurement of blood sugar level starts by a lancet (used to puncture fingers and to measure blood sugar level. And are manufactured for only one use because they are plastic). In Albania 1-lancet is used over 2-3 months without having opportunities to measure blood sugar with jacks glycemia. (In this case hygiene Lancet = 0)
2- Jacks of glycemia (special thread in which a drop of blood is placed and then read the result of the blood sugar level. A person with diabetes should use 3 chips min per day and 7 jacks max.
On the average must perform 4 measurements per day.
4 chips per day * 30 days / month = 120 jack * 12 months
= 1460 chips / year * 50 = 73,000 chips ALL / year).
Below we present a way for chips of glycemia calculations
Tab. 3: Calculating the amount of chips for measurement of glycemia.
- Needle (When using plastic syringes, they can not be purified because are produced for only one use, to make with them an injection, and after that as a rule should be “thrown out”. In practice there are sick people, whitch with these needles manage to make several consecutive injections. This thing, state does not reimburse, but his patient is obliged to buy it by itself and to use an insulin with
a pen. This infenksion causes pain and suffering for the patient).4 needles per day * 365 days = 1460 needles / year * 20 ALL = 29 200 ALL/ year.
4- Glucosed hemoglobin (HbA1c). (This analysis should be done 4 times / year * 1,500 ALL= 6,000 ALL) and it shows how the patient’s condition has been over three months.
- Hormone Glucagon (Fig. No.1)
Fig. No. 1: Glucagon is a hormone produced by the alpha cells of the pancreas. Increases the blood sugar levels. This product is used when a person with diabetes falls in diabetic coma (COMA – low sugar condition at similar rates to sleep, with complete loss of consciousness, from which the person does not wake up even after painful stimulus).
THE PATH THAT MUST FOLLOW A PERSON WITH DIABETES TO CHANGE OR INCRASE THE NUMBER OS INSULINS.
- The challenge starts from the family doctor consulting with him and getting a recommendation to the endocrinologist.
- Going to a endocrinologist doctor with recommendation, which initially provides only Human insulin.
– Human Insulin is being removed from circulation by European countries, because of side effects and hypoglycemia.
– Most effective Insulin is that Analogue, whitch these doctors only reimburse when the patient with diabetes has complications and other damages (the effect of analogue insulin is that does not bring Hypoglycemia and brings the patient near normal HB1Ac).
- If is needed more insulin, endocrinologist doctor of district, leads to Tirana University Hospital Centre with e prepared letter, even for a single insulin pen.
- Coming in Tirana accompanies the patient along with the financial loss and the stress of hospitals. With the arrival in hospital must be registered in the consultation to the endocrinologist doctor.
- Then comes the wait in queues, where will deal the confirmation, which is a simple approval signature by the specialist.
- After getting the request together with other documents that must send it in another building within the hospital and it takes just a 3-stamp in the same document where you send it:
1-copy letter to the family doctor.
2-copy letter to the doctor endocrinologist.
3-copy letter district Institute of Health Insurance, which gives another approving paper.
- This approval requires a day time and can only be obtained after 24 hours.
We must emphasize that the analysis and all the abovementioned materials reimbursed not only in European countries but even in the regions as Macedonia.
It is regrettable that in our country are not reimbursed and patients with diabetes are injured every day of their lives!
What is the loss to the patient and the state?
Patients with diabetes, not having the ability to care properly for the disease, for financial and bureaucratic reasons, leads itself to other complications of health as damage to the eyes, the heart, brain, kidney, wounds, ulcers diabetic and nervous system damage!
These financial and health concerns of patients if we add the hospitalizations, treatment specialists, other medications, except “time” factor that is irreplaceable. It is understood that the high cost of failure leads to some measure blood sugar or frequent tests in everyday life.
- We want to review the financing schemes and long-term reliability, so that with our cooperation as a patient organizations to reduce the number of disability and to his concerns.
- We also ask repetitive review procedures for the preparation of kemp retirement annually documents and social assistance given to people with diabetes.
- Also among we want to review the possibility reimbursement of diabetic pumps for children and young people who have an unbalanced diabetes and complications caused by diabetes, as it happens in our neighboring country Macedonia.
- The fight against this “sweet”, smooth, abrasive disease, which “eats” is not just a matter of humanism and solidarity. We notice that from state institutions as the Insurance Institution of Healthcare Directorate, the Council of the Municipality of Tirana No.5 Unit, Department of the University Hospital Center Tirana, etc.
- There is a growing interest in cooperation with the Association of Children and Young People with Diabetes.
- Was taken over from us to accomplish a total refund glucosed hemoglobin analysis on the entire territory of Albania, needles refund , lancets, fiche for 800 childrens.
We also hope that will pay more attention to facilitating the employment of this community.
We have not need for good words, but for good and worth people and values …!
We think it is time that with our union as the representative of children and young people with diabetes, to raise our voice more strongly to be heard and to have support for rights that belong to us for years.
Association of children and youth with diabetes aims not only to show solidarity and support its members, but also to create opportunities for cooperation with all official institutions, social and humanitarian to simplify as more as possible the burden of this disease, which is growing at alarming numbers.
I have the honor to thank all the supporters of the Children and Young People with diabetes for your time and attention !!!
Thank you !!!