Health care reform and the $22,000 employee

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11/25/2009

So, I am reading some health care reform news today on Crain's New York Business.com and there is an article about how disease state management programs can reign in costs for diabetes patients. I don't belong to such a program, but I agree with the concept.

Apparently, UnitedHealthcare tested just such a plan this year with three national employers. What shocked me was that United says the average health care costs for an employee with diabetes (keep in mind, if they are employed, they aren't the blind, legless, dialysis patients) are $22,000 a year.

$22,000?! How is that possible? That's almost $500 a week. Does that seem high to anyone else?

I logged on my insurer's Web site to review my diabetes-related claims thus far for 2009. My total costs (both out-of-pocket and paid by the insurer) are roughly $4,586.71. That includes prescriptions (almost half), assorted bloodwork (standard for diabetes patients), one visit to the endo and two visits to the dietician.

Where on earth did the other $16,413,29 cents go? Am I just better than average at controlling costs? (Despite having insurance, I am always mindful of how much my insulin and test strips are if I paid retail). Do other people with insurance just say yes to everything cause someone else is paying for it? Do their doctors feel more free to order tests, etc? Are the costs just out of control?

Of course, I see the doc a little less frequently then others, stretch out my scripts longer than recommended, have skipped the eye exam so far this year and haven't gotten my $25 flu shot (Sorry Dr. B. they aren't available in Maine this season).

But I take care of myself, as recommended and try not to waste health care dollars—mine or the insurers. Isn't that what health care reform should be about?

Theresa Flaherty, Type 1, 10 years, 3 months

Comments

I encourage you to check out LPIHO, a network of pharmacists based in the Lancaster, PA, area that partners with employers to help their employees with diabetes manage their disease. The Lancaster Business Group on Health has the reports for the program, known as the BRiDGE project, for the last few years on their website, www.lcbgh.org .

I am curious: was the $22,000 figure based solely on healthcare claims? Or did it include costs for the employers as far as productivity decreases and days of work missed? That does seem to be high.