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Massive diabetes bill underlines need to improve prevention, chronic care

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The nation’s health bill for treating diabetes has virtually doubled and is growing rapidly as the incidence of the disease escalates.

In a finding that lends urgency to efforts to bring down the prevalence of type 2 diabetes, the Australian Institute of Health and Welfare (AIHW) found that between 2000-01 and 2008-09 health care spending on diabetes surged from $811 million to $1507 million, driven by an increase in patients as well as improvements in treatment and access to care.

According to the Institute, the 86 per cent increase in diabetes-related expenditure substantially outstripped the 60 per cent increase in spending on all diseases over the same period, and diabetes’ share of total disease expenditure rose from 2 to 2.3 per cent.

The results underline fears that diabetes will become an enormous drag on the health system unless efforts to prevent type 2 diabetes developing are stepped up.

The prevalence of the disease increases as populations get older and fatter, and studies suggest it will become a huge financial burden if current health and lifestyle trends continue.

Around 85 per cent of diabetics have the type 2 version and, of these, 77 per cent are aged 55 years or older.

In its report, the Institute cited estimates that the number of people with type 2 diabetes (officially estimated at 986,900 people in 2011-12) will double by the middle of the century, and the associated health bill will increase two-and-a-half times, solely as a result of ageing.

If current growth in the rates of obesity and inactivity is sustained, researchers warn the diabetes health bill could increase four-fold.

In a sobering codicil to its report, the Institute admitted its figures were likely underestimates of the true extent of health spending on diabetes because of limitations in the data and methods used in collecting it.

Underlining AMA concerns about shortcomings in the health system regarding the treatment of chronic conditions, the AIHW report showed that the major chunk of spending on diabetes was for hospital care.

In all, $647 million (42 per cent of overall diabetes expenditure) in 2008-09 was for hospital admitted patient services, compared with $498 million (33.1 per cent) on medications and $362 million (24 per cent) on out-of-hospital medical expenses.

Highlighting how costly periods of hospitalisation are, and the enormous savings to be made by helping patients manage their condition and minimising hospital visits, the Institute said each hospital admission cost an average of $7600, compared with an average of $42 per service for out-of-hospital care and an average of $47 for each prescription of blood glucose-lowering medication.

Disturbingly for governments and hospitals trying to manage tight budgets, the signs are that hospital episodes for diabetes patients are increasing.

The fastest-growing area of spending on diabetes care between 2000-01 and 2008-09 was for hospital care, up 116 per cent, the vast majority (84 per cent) involving patients with type 2 diabetes.

The AMA has called for significant improvements in arrangements to help GPs manage and coordinate treatment for patients suffering chronic disease.

AMA President Dr Steve Hambleton told the National Press Club earlier this month that GPs are increasingly treating older patients presenting with two or more complex chronic conditions simultaneously, including diabetes, hypertension, cholesterol-related disorders, depression, anxiety, arthritis and asthma.

Dr Hambleton said the Department of Veterans Affairs’ Coordinated Veterans Care program, which provided additional support for GPs to comprehensively plan and coordinate veteran care with the support of practice or community nurses, should be the model for a broader program across the health sector.

Adrian Rollins