Government & Medicine

I've got you under my skin

Expensive insulin pumps offer superior glucose control ? but who's going to pay? Ontario inches toward pumping up diabetes device funding

By Robb Beattie

When a New Brunswick couple won millions in the lottery last month, they said the first thing they'd do with their winnings was buy their diabetic daughter a brand new insulin pump.

The relief they felt highlights the tremendous financial pressure felt by Canadians with diabetes who have to cover the cost of their insulin pumps and other supplies. While all but the Maritime provinces cover the cost of insulin for low-income residents with diabetes, only the Yukon and Nunavut cover the cost of insulin pumps and only they and Alberta cover the cost of pump supplies.

Ontario Member of Provincial Parliament (MPP), Michael Gravelle, representing Thunder Bay Superior North, aims to change all that in Ontario. Bill 55, an Act to Amend the Health Insurance Act received its second reading in the House on April 22. "As an MPP for nine years, I've had many constituents approach me who were not able to access the pump because of the cost," says Mr Gravelle. The pump costs about $6000 and people pay another $4000 a year for supplies. "If you don't have a private insurance plan, you can't afford it," Mr Gravelle says. "The people who really understand the value of the pump are truly desperate to get their child or themselves on it. People have made remarkable sacrifices to get it."

The preamble to the Bill stresses the cost to the health system of diabetes complications. "Diabetes is the leading cause of blindness, amputation, kidney failure and heart disease in Ontario," it states. The 6% of Ontarians with diabetes account for 32% of heart attacks, 43% of heart failure cases, 30% of strokes, 51% of new dialysis patients and 70% of amputations. "I became absolutely convinced over the course of time that despite the up-front cost of the insulin pump, it would save the healthcare system a great deal of money," says Mr Gravelle. "It's clearly a medical device that really works to avoid long-term complications."

THE LONGEST JOURNEY
Mr Gravelle had written health ministers about access to insulin pumps in the past, and when his opportunity to present a bill came up, he thought this was a chance to make a real difference. "The Minister of Health encouraged me to go forward with the legislation and was there in the legislature on April 22 when we had the debate and stood and supported the legislation," says Mr Gravelle. "That to me was very significant."

Health Minister George Smitherman's endorsement is also an encouraging sign for Alexis Mantell, spokesperson for the Canadian Diabetes Association. "I cannot remember the last time the legislature of Ontario talked about diabetes," she told NRM, "so I'm heartened by that and so are people with diabetes." The battle's not over yet, though. As a private member's bill that entails additional spending, Bill 55 must receive a buy-in from the Minister of Health and government before it can go through. However, the fact that Mr Gravelle is a member of the ruling party will help. "This is the third time a private member's bill has been introduced in the Ontario legislature for diabetes supplies," says Ms Mantell, "and this one has gotten the farthest."

With more than two million Canadians now suffering from diabetes and numbers set to grow rapidly as the population ages, coverage of the medications, test strips, glucose meters, syringes, lancets and insulin pumps people need to control their diabetes has become a hot topic. The Canadian Diabetes Association has upped the pressure by publishing report cards tracking each province's progress in improving diabetes care. Their 2003 report found that people with diabetes still faced a heavy financial burden, though they noted progress in a couple of provinces.

What the Diabetes Association would like to see is some real progress on a national strategy for prevention, treatment and control of the complications of diabetes. Should Ontario take the lead by passing Bill 55, that battle would be half won. The bill will next go before the Standing Committee on Justice and Social Policy, likely before the end of the spring session and may make it to a third reading by the fall.