by D'Mine Correspondent William "Lee" Dubois
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Along with the mystery of how much wood a woodchuck could chuck if a woodchuck could chuck wood, is the mystery of how many test strips diabetic children need to stay safe. At least that's what an obscure panel of medical professionals in Washington state decided at the end of a $83,432.70 year-long review of the medical evidence surrounding the use of test strips by children. The DOC was up in arms recently about the possibility of this state health board limiting children with diabetes to coverage for just 5 test strips per day!
Talk about your random, unethical, and ill-informed ways to save a buck on healthcare.
It's frightening to realize that we're entering a time when our society is forced to pick and choose what we may or may not have to stay healthy, no matter how critical those supplies and services may seem. But that's where the spiraling costs of health care have brought us.
How did this all play out in Washington state? Here's the backstory, in a nutshell:
Over a year ago, the administrators of social welfare programs in the state of Washington took notice of the fact that there were no limits on test strips for diabetic children, while adult diabetics had strict limits. Seizing the opportunity to save a buck, the administrators put the question to the state's Heath Technology Assessment program, the HTA.
The HTA chooses which medical technologies the state of Washington will pay for and which ones it won't, by looking at safety and effectiveness of medical technologies and then weighing the cost and benefits of the technology for both patients and the state budget.
HTA decisions affect social welfare programs, state employees, and a slew of other health insurance programs that the state subsidizes. For all practical purposes, HTA decisions effect health care coverage of pretty much everyone in Washington state, and their approach is being considered on the national level as part of health care reform.
While at first glance it might look like a bunch of bean-counters are rationing health care, the program is actually highly transparent and seeks public and industry input at every phase of the processes. And on top of that, the final decisions are made not by bureaucrats, but by a panel of practicing clinicians.
Test strips are actually surprisingly mundane compared to the technologies the HTA usually reviews. Looking at a list of technology reviewed by the HTA over the last few years I see they've evaluated Computed Tomographic Colonography, Discography, and Hyaluronic Acid Viscosupplementation.
I have no frickin' idea whatsoever what any of those things are, but I'm sure they are VERY IMPORTANT to the patients who need them.
Since 2007, the HTA has reviewed 21 medical technologies, canning insurance coverage for 10 of them and continuing to cover 11 others, in the process trimming $31 million dollars per year off of the state's medical spending. Nice for the state. Very bad news for patients dealing with various serious medical conditions.
In the case of potentially limiting glucose test strips for children, the HTA contracted with a firm called Spectrum Research to scour the clinical literature to find out what is known and not known in this area. Spectrum's report to the HTA is no small thing. In the end there were four documents totaling 505 pages.
So what did they find? The report's summary states that "There are no randomized controlled trials or observational studies that evaluate ... testing."
In short, more than 500 pages to say, "we really don't know squat."
Of course, it's old news now, but between the time when Spectrum stated there wasn't much evidence to support the use of test strips, and the HTA Coverage Decision Committee's decision upholding unlimited strip use for children, the public and "stakeholders" weighed in. Responses supporting unlimited use were filed by American Diabetes Association, The Endocrine Society, and the Pediatric Endocrine Society. Industry came to bat with input from Abbott (who actually hired yet another medical research firm to write a counter-report), Bayer, and Roche.
Two things stand out about Washington state's approach in seeking a balance between dollars and health. First, cost is openly discussed and considered as part of the coverage review—along with what has been scientifically proven about the technology. It sure beats the hell out of the status quo where a Wall Street Suit who's only looking at a balance sheet decides my health destiny.
And secondly, the state has put the final say in the hands of medical professionals who actually work in the trenches, not in the hands of bean-counters, bureaucrats, or politicians. So even though the diabetes community got a scare, there does seem to be some merit to this model.
Will Washington state's HTA become the national model?
We could do worse. After all, the mere fact that test strips for kids weren't chucked to the curb may be the ultimate testimony that this system actually works.
For a more in-depth report on this story, see Wil's War-and-Peace-length version at his personal blog, LifeAfterDx. But you'd better eat first; it's a looooooooooong read.