I've been reflecting further on the post BELOW on my blood-sugar machine. Oscar Wilde once said that a cynic is someone "who knows the price of everything and the value of nothing". We in Britain take for granted that our healthcare is provided free at the point of delivery. When I got my True Track monitor and the testing strips to go with it, I'm rather ashamed to say that it never occurred to me how much it cost. The gadget itself is about £15, and the strips, I found out yesterday, cost about 26p each. I'm using four a day. Now that's not a huge amount in itself, but when you add on the cost of the pills I am taking it will come to quite a lot over a month.I wonder whether doctors should be mandated to give the patient a costing of what their treatment actually costs. We may value our treatment, but we should also know how much it is costing the NHS to provide it.
The NHS Blog Doctor has THIS post, which tells me that, as a diabetic, I now get free prescriptions for life, and I can get free supplies of Viagra. Well that's certainly perked me up. He also says...
Take look at Diabetes.co.uk, a thoroughly excellent site, essential reading for all diabetics. They review various testing systems here. But notice there is no talk of vulgar things like money. No mention of cost. It does not matter. The taxpayer picks up the tab. In the US, TrueTrack are cost conscious; they are in competition with many other manufacturers and do their best to keep prices down. If they do not, they go out of business.According to the Journal of Public Health (here), in 2004 the British Taxpayer spent just under £6 million on glucose monitoring equipment and that annual cost is doubling every three years.
When I was first diagnosed my GP explained about how diabetes causes arteries to fur up, which can lead to a much higher risk of strokes and heart attacks. She said the aim now was to unfur the arteries - and then as an aside she added that this would lead to much better erections. Nice weather today, I said, looking at the floor in a typically British fashion. Still, what better incentive could there be to get one's blood-sugar levels down!
As someone said in the comments, it does seem rather odd that I, as a diabetic, could get a free prescription of Viagra (believe me, it's not something I shall be taking advantage of [enough - ed]) and yet someone with erectile disfunction has to pay for it. Very strange priorities. I wonder what Dr Ruth would say.
Note: For the uninitiated, Dr Ruth was famous in the 1990s for her sex therapy advice. She was a regular on the Clive James show and became known for the rather strange way she pronounced the word 'erection'. Think hebrew.
25 comments:
Ref the true cost of prescriptions. Some time back the doctor who writes in the Times did this by accident; the prescription printed the true cost on it. The reaction from his patients was remarkable, and he too wondered why this was not done intentionally.
If you get a free prescription of Viagra the lord will punish you with even more spam emails selling you the s**t.
It wasn't that long ago that (adult) persons with diabetes had to pay for all their medication. It was only when the Government handed out free neeedles etc. to drug addicts that the, as was then, Diabetics Association campaigned and won the fight for free needles etc. for those with diabetes.
I am not sure you have had the right advice about your diabetes yet. It is a symptom. The causes you are right could be diet, but there could also be underlying causes.
If you don't get a full check-up, the kind that is not available on the NHS, you could find that in another two to three years you develop other symptoms, which could be more serious.
I experienced a gradual decline in my health starting with high levels of insulin as a symptom. Later I had heart trouble, stomach problems and more. It turned out I had high levels of an insecticide in my body from childhood.
Once that was chemically extracted from my body, my recovery began. Until then it was one blow after another.
You grew up on a farm Iain, where you worked as a teenager, I believe. You could some long term trouble from that - or you could have high levels of mercury from fillings, or of lead from water. Or a combination of loads from numerous sources accumulated through your life.
Your toxic load could be becoming too much for your nervous system, the body's regulator, especially with your high output workload, and it could be beginning to cause organ failure.
If you have underlying causes, these should also be dealt with as well as diet. I can recommend you where to go if you email. It will cost you about GBP 4000 to get a full assessment. Not cheap, but as far as I am concerned it was literally a life saver.
It might cost you less than that of course but be prepared top spend some spondoolicks....of fairly major proportions.
I could give some pointers as someone who's been through similar over a few years, if you are interested.
There are a number of things NHS Blog Doc somehow forgets to mention.
In the scheme of things, the cost of prevention of diabetes complications (which includes your test strips) is very small compared to the cost of dealing with heart attacks, kidney dialysis and all the other things that come along without good glucose control.
He also forgets to compare his £6m figure with the extra cost of GPs that I blog about from time to time (£300m a year or so).
He also forgets to mention that something like 50-75% (I think its the higher figure but I don't have the numbers to hand) of the NHS budget increases over the last decade have gone on staff costs - the unions (including the BMA) seem far keener to complain about the cost of drugs, which are relatively insignificant by comparison.
Sure, there's room for cost reductions (epecially in the cost of insulin) - but don't expect medics always to give you all the sides of the case.
Keep looking and keep writing.
matt w,i was interested to hear from a local gp near the pharmacy i run that they are actively being encouraged to trim the 'unnecessarily high level of prescribing of test-strips to type 2 diabetic patients'.apparently the health board here thinks that twice a week testing for this category of patient is sufficient.i understand ther is a push on to target this product category over the whole region(n.ireland).any thoughts?
"Think hebrew"? You mean she pronounced "erection" as "temple"?
I wonder if sedentary blogging is a cause of the increased diabetes rate...
blogging while jogging!matt w,by george,i think you've cracked it!regards,fig.
And what of the boy Dave's plan to give mums free maternity nurses to instruct 'em how to bring up their offspring? Nanny (almost literally) state gorn mad or wot?
Went to a Dr Ruth talk some years ago. Wonderful woman.
Interesting post. I have Kidney Disease, which has a clear link with High Blood Pressure. My BP is at the high end of normal (since I lost loads of weight), but I take BP tablets on doctors advice as a precaution when there would be no need if I were "normal" - so why do I pay for my prescriptions?
Might ask my GP.
In principle, that's a good idea. The problem comes with the inherent cross-subsidy in the system. An awful lot of medication costs less than the prescription charge but some costs rather more. What you're paying for with the prescription charge is not just your medication but the system that will pay for your (mind-numbingly) expensive course of cancer drugs (or whatever).
If you're getting NHS prescriptions regularly, look at getting a pre-payment certificate. It works out cheaper if you have more than 1 Rx a month, I think.
xD.
Lucky you Iain, I wish my - rather cute 32 year old female - doc would offer to help with my erections...
As for the Viagra, I think you'll find you still have to get your doctor to prescribe it for it to be free, so don't get too excited.
Martin:
My BP is at the high end of normal (since I lost loads of weight),
what is normal? we're all different aren't we?
In East Africa, it's normal to have a "high" cholesterol count.
NHS Doctor is wrong. You only get free prescriptions for Type 1 diabetes. Sorry to burst yer bubble Iain but I've been here already...
Tartan Hero, er, no, you're wrong. I get free prescriptions. Maybe it's different north of the border!
Jesus H. Christ, Iain, there is so much codswallop in the above comments that I feel obliged to respond.
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The rant from Tapestry is utter quackery:
[“You grew up on a farm Iain, where you worked as a teenager, I believe. You could some long term trouble from that - or you could have high levels of mercury from fillings, or of lead from water. Or a combination of loads from numerous sources accumulated through your life. Your toxic load could be becoming too much for your nervous system, the body's regulator, especially with your high output workload, and it could be beginning to cause organ failure.”]
Dear oh! Dear.
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Matt W
[There are a number of things NHS Blog Doc somehow forgets to mention.
In the scheme of things, the cost of prevention of diabetes complications (which includes your test strips) is very small compared to the cost of dealing with heart attacks, kidney dialysis and all the other things that come along without good glucose control.]
I was not suggesting that prevention of diabetic complications was not worthwhile. It most certainly is and, yes, prevention is cheaper in the long run. But it is not cheap. I am not suggesting that we should not do it. I am suggesting that UK citizens are unaware of the real costs of medicine and it is only when you land in the USA and have to pay for some test strips that you suddenly realise.
[He also forgets to compare his £6m figure with the extra cost of GPs that I blog about from time to time (£300m a year or so).]
It is not “my” figure. It is from validated Public Health Research. The cost of GPs may be ridiculous – but that is, in context a complete non sequitur.
[He also forgets to mention that something like 50-75% (I think its the higher figure but I don't have the numbers to hand) of the NHS budget increases over the last decade have gone on staff costs - the unions (including the BMA) seem far keener to complain about the cost of drugs, which are relatively insignificant by comparison.]
I did not “forget” to mention it. I did not mention it as it was not relevant to the point I was making that in the UK diabetics are lucky to get free treatment, but many of them do not realise the hidden costs.
[Sure, there's room for cost reductions (epecially in the cost of insulin) - but don't expect medics always to give you all the sides of the case.]
My point was that a lot of companies rip of the NHS by charging high prices for drugs and equipment. They would not get away with it in the USA. Finally, where is Matt W’s unnamed blog hiding?]
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Fig 1
[matt w,i was interested to hear from a local gp near the pharmacy i run that they are actively being encouraged to trim the 'unnecessarily high level of prescribing of test-strips to type 2 diabetic patients'.apparently the health board here thinks that twice a week testing for this category of patient is sufficient.i understand ther is a push on to target this product category over the whole region(n.ireland).any thoughts?]
Once a Type 2 diabetic is stable, it is not necessary to test blood as regularly as a Type 1 diabetic. This is nothing to do with cost cutting. It is to do with sore thumbs and unnecessary testing. It continues to amaze me how the ignorant talk with such pseudo-authority.
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Matt W
[I wonder if sedentary blogging is a cause of the increased diabetes rate...]
Certainly agree with that, Matt. I have put on weight since I started blogging, and I bet Iain has too.
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Tartan Hero
[NHS Doctor is wrong. You only get free prescriptions for Type 1 diabetes. Sorry to burst yer bubble Iain but I've been here already...]
That one is easy. It is totally wrong. All Diabetics, Type 1 and 11 get free prescriptions for everything.
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Phew! I feel better for that. Amazing how my short post about the merits of the NHS and the hidden costs of treating diabetics stirs up so much ignorance and vitriol
John
I have diabetes too.
When I was first diagnosed I had to pay for my prescriptions, I think it was about £7 per item. For 4 items a month it's not an awful lot of money, but it nevertheless hurts a bit when you get them all in one lump.
I later became entitled to free prescriptions. By now it was 5 items per month.
But when I left the country to live elsewhere... guess what? I now buy the same pills over the counter and pay the full market rate. And the dirty little secret is that the full market rate is less than half what I was paying for the exact same stuff at the 'subsidised' rate of £7/item in the UK.
To summarise, I used to pay through the nose for the NHS. When I got ill, they ripped me off even more by overcharging for my prescription items. What a good deal.
Answering the good Dr in detail:
>The rant from Tapestry is utter quackery:
Agreed - with the slightly more charitable note that change of lifestyle for Type II could cause an improvement which can be perceived to be down to other causes.
>I was not suggesting that prevention of diabetic complications was not worthwhile. It most certainly is and, yes, prevention is cheaper in the long run. But it is not cheap. I am not suggesting that we should not do it. I am suggesting that UK citizens are unaware of the real costs of medicine and it is only when you land in the USA and have to pay for some test strips that you suddenly realise.
Perhaps. I can only speak to my own case. As a Type 1 I believe that my treatment costs of the order of £800-1200 a year (last time I checked, using data from the BNF - direct costs, staff time and admin not included of course).
I am also aware how much more expensive it will be in the long term if treatment cost reduction forces limitation of patient self-monitoring.
>It is not “my” figure. It is from validated Public Health Research. The cost of GPs may be ridiculous – but that is, in context a complete non sequitur.
The point is not that it is a nonsequitur, but that the £6 million you quote is one apple on a huge tree - it is part of the same NHS budget, and therefore relevant context.
[He also forgets to mention that something like 50-75% (I think its the higher figure but I don't have the numbers to hand) of the NHS budget increases over the last decade have gone on staff costs - the unions (including the BMA) seem far keener to complain about the cost of drugs, which are relatively insignificant by comparison.]
>I did not “forget” to mention it. I did not mention it as it was not relevant to the point I was making that in the UK diabetics are lucky to get free treatment, but many of them do not realise the hidden costs.
See para above. And the BMA IS always banging on about the relatively proportion of the costs associated with drugs.
>My point was that a lot of companies rip of the NHS by charging high prices for drugs and equipment. They would not get away with it in the USA.
I'd agree with you on that one, but the savings would be small as drugs only constitute around 13% of the NHS budget.
>Finally, where is Matt W’s unnamed blog hiding?]
Where it normally hides when I post on here several times a week as Matt W - mattwardman.com.
You linked to my post about Patsy's 35k payoff.
[i was interested to hear from a local gp near the pharmacy i run that they are actively being encouraged to trim the 'unnecessarily high level of prescribing of test-strips to type 2 diabetic patients'.apparently the health board here thinks that twice a week testing for this category of patient is sufficient.i understand ther is a push on to target this product category over the whole region(n.ireland).any thoughts?]
>Once a Type 2 diabetic is stable, it is not necessary to test blood as regularly as a Type 1 diabetic.
This is nothing to do with cost cutting. It is to do with sore thumbs and unnecessary testing.
Agreed - the basic insight is part of lesson 1 for any new diabetic.
However, the national treatment framework places the weight on self-management. It should basically be for the patient to decide how much testing is necessary in consultation with their medical advisers, and whether they prioritise "sore thumbs" over learning to manage their diabetes properly. Any who do are fools imo.
>It continues to amaze me how the ignorant talk with such pseudo-authority.
The source here is a pharmacist talking of a first hand conversation with a GP. Which one are you suggesting is "ignorant" and talking with "pseudo-authority"?
>I have put on weight since I started blogging, and I bet Iain has too.
I - on the other hand - have lost it since I started blogging. BMI (if we ignore BMI's dodginess at the edges - cf Sly Stallone comes out obese) is back to roughly where it should be. I have no idea why, as I do less exercise for now.
To bring a touch of levity to a passionate thread, the best purchase I have ever made for Db was a pair of 1910 cast iron scales that weigh about half a hundredweight and sit in my hall. Unlike modern scales, they are accurate 5 years later. I have seen an identical set in National Trust Cragside.
>That one is easy. It is totally wrong. All Diabetics, Type 1 and 11 get free prescriptions for everything.
At the risk of being an anorak, you only get the free prescriptions if you are treated with insulin or tablets, not if your treatment is "diet and exercise". Those people are still diabetics, and have to pay for all their prescriptions like everyone else.
>Phew! I feel better for that. Amazing how my short post about the merits of the NHS and the hidden costs of treating diabetics stirs up so much ignorance and vitriol
Vitriol is - in my opinion - completely understandable in the context of the new GP contract (£2 billion extra costs and counting due to Patsy's idiocy).
I don't think you ahve refuted a word I said - other than to argue that it is not relevant (on which I disagree - these things must be debated in the round).
Cheers
Matt W
>When I was first diagnosed I had to pay for my prescriptions, I think it was about £7 per item. For 4 items a month it's not an awful lot of money, but it nevertheless hurts a bit when you get them all in one lump.
That would put you over the cost of a season ticket even now.
A year's prescriptions cost at present around £100 (I think).
Did no one tell you?
Ouch.
Diabetes type 2 : cut right down on sugar and carbohydrates; you'll lose weight, your blood pressure will come down, you'll sleep better and your diabetes should just disappear.
>Diabetes type 2 : cut right down on sugar and carbohydrates; you'll lose weight, your blood pressure will come down, you'll sleep better and your diabetes should just disappear.
It never disappears, but may decrease.
Just don't slip on the ice. (Sorry - in joke for high protein diets).
matt w,many thanks for taking the trouble to respond to the points j crippen makes.(glad he's not my doctor if he is one;his bed-side manner leaves a lot to be desired!)i couldn't be bothered to respond as it was fairly clear that he completely got the wrong end of the stick here.
I am diabetes type 2 as well. My daughter is type 1.
When I see what I get from the State to keep us alive, I am eternally grateful. I am also aware of the cost - if you think type 2 medication is expensive, try type 1.
It also makes me stupendously angry that people take these medicines for granted. They have no idea how much they cost and show a stunning lack of gratitude.
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