the same price control methods may partially explain this.12
Facing the cost of inaction
Major differences were also found regarding the pricing policy applied to medicines and those applied to medical devices. There is a lack of publicly available information on the pricing of diabetes devices. Some evidence suggests that this is because regulations and policies for medical devices are relatively new. Also, the regulatory implications of the distinction between medicines and medical devices may go some way to explaining these differences.
Ensuring access to diabetes medicines and devices is certainly a costly, complex and resource-consuming challenge and it is only one element in high-quality, comprehensive diabetes care. This study by no means aimed to minimise the difficulty it represents for countries and other stakeholders; it has tried to identify bottlenecks in access and inequalities, while offering a regional perspective that may inspire new solutions based on the experiences of other countries.
â–ˇ The affordability of diabetes products for people with diabetes and for health systems can be supported by adequate price regulation policies. However, such a policy tool has yet to be rolled out systematically throughout the Region or to include all products. Unfortunately, publicly available information on these aspects is scarce.
Finally, our findings highlighted the differences in financial support available to different categories of people with diabetes. Differentiated schemes may provide additional support to vulnerable groups or for treatment that very few people could afford on a regular basis. However, such mechanisms remain partial and selective in certain countries and may create new, or widen existing, inequities. So although the creation of safety nets in many European countries has to be a widely acknowledged social advancement, careful consideration should be given to their implications for the categories excluded from these schemes. Furthermore, the difficult economic situation in many European countries is likely to have impoverished some people with diabetes, making it more difficult for them to pay for the expenditure they were previously able to afford for the treatment of their condition. The efforts of some countries to maintain public financing of diabetes products despite constraints on their budgets are not to be underestimated. However, it appears that the new reality faced by a number of people with diabetes may require new safety nets to be created in order to ensure that all people with this condition are able to afford the treatment they need.
â–ˇ Differentiated treatment benefits may be a strong tool to ensure equity. However, the impact of such schemes beyond the target groups should also be carefully considered.
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Improving access to diabetes medicines and medical devices may appear too complicated and costly for European countries in a time of economic crisis. However, the prospect of short-term savings should not hide the long-term consequences of inadequate access to diabetes medicines and devices. Access to supplies is an essential element of diabetes care. Unmanaged or poorly treated diabetes can lead to disabling and life-threatening complications.
Studies in various Western European countries have demonstrated that the costs of managing diabetes-related complications are far greater than the cost of care for controlled and well-managed diabetes. Research on type 2 diabetes has revealed that managing diabetes complications such as cardiovascular or kidney diseases is much more expensive, mainly due to hospitalisation costs.5,14 In addition, the cost of inpatient care for people with diabetes is higher than outpatient diabetes care.14 A recent OECD report estimated that the EU average number of hospital admissions due to uncontrolled diabetes with diabetes-related complications was more than double the EU average for uncontrolled diabetes hospital admissions without complications. Moreover, drugs to treat complications make up the largest proportion of diabetes-related pharmaceutical costs.5 The cost of untreated or poorly treated diabetes also represents an enormous financial burden on the economy and wider society due to loss of productivity, absence from work, disability and the challenges created for care providers.5 This study proves that access to diabetes care is an investment in a healthier and more productive society, as well as a contributor to long-term economic growth.