Whilst I’m not participating in D-Blog week this week, there are two topics on the list which caught my eye. The first of these is the cost of a chronic condition. Reading through the various posts, and given the state of healthcare in the US at the moment, many people have majored on the financial costs of living with a chronic condition. And those are very real, regardless of whether you live in the US with the crazy insulin prices and insurance schemes, or the UK with the NHS, full, free access to insulin and some treatment technologies, and then the need to top up if you want the best available solutions, or somewhere in between.
But, and there’s a big but, what about the other costs of living with Diabetes? Or any other chronic disease/condition (pick your own word here, both are interchangeable)? Let’s just assume for one moment that the issues with paying for your supplies/life-giving medications goes away or is massively reduced (as in most of Europe and Australia), financials are not the only costs that need to be considered.
Personal Costs
How many times do you read comments from people that are unable to work as they are unable to manage to live safely with their diabetes? There are many people that get hugely impacted by chronic conditions, making them unable to work and unable to participate fully in society. This leads to many other issues, including, but not limited to, isolation, the loss of relationships, suffering from poverty, to name but a few. Many of these are preventable, but are costs, none the less. And let’s not forget those who have struggled and ended up with losing limbs, eyesight and other complications, or those who are unable to control hypos and end up anxious and scared about any form of activity. The loss of mobility and ability as a result of diabetes is another terrifying cost that most of us will have considered at one point or another.
Whilst you see online participation on Twitter, Facebook, in Diabetes fora and bloggers, this is typically the tip of the iceberg. For every one of those there are 20 who aren’t part of this engaged group. A large majority don’t find it easy.
And that’s just those who count the cost in physical issues.
When we take a look at mental health in general, Chronic conditions typically have a detrimental effect on mental health. A report from the King’s Fund in 2012 provided the following stark image:
Or in other words, a third of those with long term health conditions have a mental health problem (and half of those with mental health problems have long term conditions).
The CDC goes into more detail:
Many other associations exist between mental illness and cardiovascular disease, diabetes, obesity, asthma, and arthritis to name a few. For example, the chart to the right shows the prevalence of major depressive disorder and other common chronic diseases. Depression is found to co-occur in 17% of cardiovascular cases, 23% of cerebrovascular cases, and with 27% of diabetes patients and more than 40% of individuals with cancer. The relationship between mental health, chronic disease and injury is significant. Many examples exist of individuals with a chronic condition or risk factor and an increased risk for mental illness such as the risk for tobacco use is about twice as high for those with mental illness compared to the general population. Injuries, both intentional such as homicide and suicide and unintentional such as motor vehicle accidents, are 2—6 times higher for persons with a history of mental illness than those without a history.
This study also has some interesting points in relation to the US healthcare system and how it could be enhanced to improve treatment access.
Bearing this in mind, there’s a vicious circle whereby the chronic condition leads to mental health problems, which leads to physical health problems as a result (as shown in the below image from a study looking at Type 2).
And if you’re the parent of a child with T1D? Then you have similar struggles: The sleepless nights; the worry about your kid’s health; and a far greater one, the guilt. Whether valid or not, parents also struggle with this. And of course, if you have financial costs to add into this, stability is not a given with any chronic condition.
On top of this, eating disorders are highly likely in T1D, and lead to physical costs. One study showed that women with diabetes are 2.4x more likely to develop eating disorders than the normal population, whilst others have shown a 38% greater prevalence in women and 16% greater prevalence in men. And that’s only looking at eating disorders.
And we haven’t mentioned Diabetes Distress.
Whilst the financial costs of living with a chronic condition are often the most noticeable and most easily identifiable, and the thing that most people consider when talking about costs, the hidden costs can be just as damaging. Half the population of the developed world doesn’t have financial issues in accessing diabetes supplies, and yet they still count the cost.
Systemic Costs
The same King’s Fund study looked at costs to the Healthcare system in the UK, coming to the conclusion that the interaction between mental health problems and long term conditions added 45% to the cost of an individual’s healthcare. Looking at individual conditions, combined with either anxiety or depression, they drew the following conclusions:
That there are significant cost increases in individual care with individual conditions combined with anxiety or depression – as much as 75% more cost when anxiety and Diabetes are taken into account. Note that this is US data and gives a good indicator of why long term conditions are considered higher risk and therefore are more expensive to insure.
They also consider that between 12% and 18% of UK NHS expenditure on Long Term Conditions is on mental health.
[This is…] between £8 billion and £13 billion in England each year. The more conservative of these figures equates to around £1 in every £8 spent on long-term conditions
And we haven’t touched on the costs to the economy of these conditions – again, in the King’s Fund study, a US study is cited (Druss et al 2000), and it concluded that those with long term conditions and mental health issues (unsurprisingly) took twice as many sick days as those without. A study by Hutter et al (2010) on Healthcare Costs in Patients with Diabetes and Mental Health co-morbidities drew similar conclusions, so it seems fair to state that there is a cost to the economy and business of chronic long term conditions that is also not often understood.
Are things changing?
Whilst it has taken a long time, chronic conditions are now much better recognised as having a major psychological impact , and we see this being assessed in more and more locations, with examples being the support that Diabeter provides in the Netherlands and the introduction of Diabetes Distress screening in hospitals in the UK, along with clinic psychologists and better use of these with children. On top of that, the introduction of technologies that make living with conditions easier, such as those in this blog and the commercial solutions , all of which make living with this particular chronic condition so much easier, as I’ve previously mentioned.
When we take into account the hidden costs of living with chronic conditions, it is apparent that they are worth addressing, and doing so as soon as we, family, friends or healthcare professionals are aware they are being displayed or felt. And if you do feel as though you suffer from anything described here, seek help.
So whilst there are financial implications, regardless of the angle from which you view the costs of a chronic condition, it’s not all about the money…
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