Chronic Health Care in Chronic Condition

Yesterday (October 26, 2006), an article published in The New York Times highlighted the costs that the uninsured have on our healthcare system, and how some hospitals are approaching the problem by paying for preventative care because its less expensive than treating them in the emergency room. Patients with chronic health conditions, especially those with diabetes, were a main focus of the article.

Some people with diabetes took issue with some statements made in the article about the woman's insulin pump, specifically the claim that it "automatically adjusts her insulin levels" and felt that was not an accurate description of what an insulin pump does. To be sure, insulin pumps do adjust basal insulin delivery rates automatically, but the rates must be set by the patient and their healthcare provider based on frequent testing and trend analysis. However, my issue was not with that statement, but another one, which is as follow:

"The public hospital systems in New York and Denver, for example, have both worked to steer uninsured patients to community clinics, charging modest fees, if any. New York's public system, the Health and Hospitals Corporation, has assigned some 240,000 uninsured patients to personal primary care doctors. A computerized system tracks those with chronic conditions, and when necessary, social workers contact patients to make sure they get checkups and follow medical advice."

The system they describe in New York City references the New York City Diabetes Registry as the computerized system which tracks patients with chronic conditions such as diabetes, since it is the only condition which can effectively be tracked via a numeric value (A1C). Other chronic conditions, such as asthma or hypertension, cannot be "tracked" using such surveillance systems. That's the real reason for people with diabetes singled-out to have our health records seized without disclosure.

Aside from involuntary participation in the registry (if you have diabetes and reside in New York City, your test results are in the registry whether you like it or not), and unlike similar programs such as the Vermont Diabetes Information System, upon which the NYC registry was supposedly modeled, patients cannot opt out of the NYC registry. Health Officials like to claim that patients can opt out, but their test results are still taken without informed patient consent, they can only opt out of receiving communications (such as weight loss tips which are not useful for normal BMI patients with type 1 diabetes) from the NYC Department of Health and Mental Hygiene.

Because of this misrepresentation of information, I felt compelled to write a letter to the editor of The New York Times. Regardless of whether they choose to print my letter, some of my readers might be interested in what I wrote:

Although Erik Eckholm's October 25, 2006 article "Hospitals Try Free Basic Care for Uninsured" does shed light on a long-overlooked problem regarding the ininsured, especially those with chronic healthcare conditions such as diabetes, the author is a far too liberal with his use of poetic license, and the author and editorial staff of New York Times should be reprimanded.

I take issue with Mr. Eckholm's statement that "New York's public system ... tracks those with chronic conditions, and when necessary, social workers contact patients to make sure they get checkups and follow medical advice." by suggesting that the city's recently-implemented diabetes registry actually does anything close to that. The reality is not quite as rosy as Mr. Eckholm suggests.

The NYC diabetes registry is an attempt to address this issue, but the City Health Officials fail to acknowledge that registry fails to provide patients' lacking health insurance with even the most basic the tools necessary to effectively manage their conditions. For example, test supplies, medicines and routine labwork aren't provided, so predictions that the program will improve patient outcomes seem rooted more in wishful thinking than in the reality of our nation's troubled healthcare system.

Ultimately, the U.S. needs to acknowledge that chronic medical conditions cost money to manage, and perhaps someday will finally acknowledge that the uninsured need more than healthcare tips to prevent their conditions from spiraling into more costly complications. Until that happens, public health officials and legislators remain in denial about the very basic need for affordable healthcare solutions.

If you are interested, please see my previous post on the NYC Diabetes Registry at http://sstrumello.blogspot.com/2006/02/response-to-nyc-a1c-tracking-plan.html for more information. Also, please comment if you have any thoughts on the New York City Diabetes Registry.