Together through collaboration with a fellow classmate of mine who is from Manitoba (thank you Sheila for contributing the Manitoba perspective to which I have applied to this post), we have developed a basic contrast of one of the most impactful chronic disease of our country: diabetes. The three categories of contrast shared were surveillance, management and funding.
Surveillance:
Alberta
According to 2009 data from Alberta Diabetes Link.ca which was also congruent with the data from Alberta Health Services as it would appear as though they are using the same reporting statistics from the same time interval:
‘In the last ten years, diabetes rates in Alberta have almost doubled.
Approximately 1 in every 20 Albertans is currently living with diabetes. That is equivalent to over 205,000 people.
In 2009, 19,324 new cases of diabetes were reported in Alberta. This equates to more than 1,600 new cases a month or 54 each day.
In Alberta, the incidence and prevalence of diabetes in men is greater than women across older age groups.
Of the Albertans diagnosed with diabetes, 90-95% will have type 2 diabetes.
Adults with diabetes see family physicians and specialists 2-3 times more often than those without diabetes.
Adults with diabetes on average spend 3 more days in hospital compared to those without diabetes.
The North, Edmonton and South zones have the highest age-adjusted prevalence of diabetes, while the Calgary and Central zones are below the provincial rate.
The total number of GP visits in adults with diabetes has almost tripled in the last 15 years.
Specialist visits for adults with diabetes have steadily increased over the past 15 years.
Albertan children with diabetes aged 1-4 years had the greatest number of visits to the emergency department as well as total days in hospital.
Adults with diabetes spend greater than 3 times the number of days, and children and adolescents spend almost 9 times the number of days in hospital each year than the general population.
The aging population has the highest prevalence of diabetes in Alberta. This population tends to have additional health problems that subsequently increase the burden on Alberta’s health care system.’[1]
Manitoba
‘The Manitoba Center for Health Policy was established in 1990 and focuses on the health and the determinants of health of Manitobans. It manages a Population Data Repository and uses it to research factors affecting Manitobans healthcare, health programs and policies and how they impact health outcomes (University of Manitoba RFHS, 2019-2020).[2] My classmate notice that many of the Manitoba government websites, reports and documents are older and with the ever changing health of Manitobans and that she pointed out that surveillance was obviously lacking if reporting wasn’t being kept up to date – which is concerning as what kind of statistical evidence is the government using for management/funding if they don’t have accurate, up-to-date information.
• Manitoba has the highest concentration of Indigenous people among Canadian provinces
(16.7%). About 13% of Canada’s First Nations people live in Manitoba. The self-reported rate of diabetes is higher among First Nations adults living both on and off-reserve than among
Non-Indigenous people.
• Overweight and obesity affect about 39% and 32% of adults in Manitoba respectively.
Both of these rates are higher than the Canadian average. Approximately 28% of Manitoba youth are overweight and 11% are obese.’[3]
Management
Alberta
Alberta Health Services (Alberta’s provincially funded health care system) offers a program called the “Regional Diabetes Program” to support individuals affected by pre-diabetes through classroom education. Such services include: education, insulin management, information and support line, diabetes assessment and management, in person or telephone follow up and insulin pump consultation. Some of the education classes include “Diabetes- Health Eating” and “Diabetes: Meal Planning” and “Physical Activity and Type 2 Diabetes” amongst many others. [4]
Manitoba
• ‘Manitoba has developed and distributed the Manitoba Diabetes Care Recommendations (2010),
which are consistent with Diabetes Canada’s Clinical Practice Guidelines for the Prevention and
Management of Diabetes.
• Manitoba released Diabetes in Manitoba: A Call to Action (2009) to strengthen existing diabetes
partnerships and build new ones to reduce the burden of type 2 diabetes.
• Manitoba released Diabetes in Manitoba 1989–2006: Report of Diabetes Surveillance (2009).
• Reduce Your Risk (2008) is a province-wide public education campaign that helps Manitobans
to identify and reduce their risk for type 2 diabetes.
• Manitoba has established a retinal screening program for northern communities (2007) which screens for prediabetes in Winnipeg. It has enhanced funding for several self-management tools.
• Manitoba’s Physician Integrated Network (2006) seeks to improve primary care for chronic disease management, including diabetes, through multidisciplinary teams and the use of electronic medical records.
• Manitoba’s Chronic Disease Prevention Initiative (2004) promotes healthy eating, physical activity and smoking cessation.
Despite all these recommendations and programs instituted across Manitoba, you can see many of them are out of date and reports on how effective they have been is difficult to locate. Diabetes Canada (2018) recognized Manitoba did face some challenges they have in gaining effective management of Diabetes in Manitobans such as’[5]:
Funding
Alberta
On March 22, 2018 Diabetes Canada stated posted the following statement from then Finance minister Joe Ceci in regards to test strips and the cutbacks for test strip funding in Alberta:
‘ “This news is disappointing as we have been urging the government to take action by investing in evidence-based measures that will keep Albertans with diabetes healthy and reduce risk of costly and serious complications,” ’says Scott McRae, regional director with Diabetes Canada .
A key priority is increasing the public funding of self-monitoring of blood glucose test strips beyond what is currently available for Albertans living with type 1 or type 2 diabetes. Diabetes Canada believes that self-monitoring of blood glucose is an essential tool in the treatment and management of diabetes and helps to prevent short-term problems and prevent or delay the longer-term complications of diabetes, including heart attack, stroke, blindness, amputation and kidney failure.
‘ “Appropriate frequency of checking blood sugar levels has been associated with improved health outcomes for people with diabetes and helping to manage costs in the healthcare system, such as decreased hospitalizations,” ’ states McRae. ‘ “Not investing in diabetes care will only put pressure on our emergency rooms and hospitals caring for people with costly complications of diabetes.” ’[6]
Also just to note that diabetic residents in Alberta can apply for diabetic supplies under the Palliative Care Health benefits Program” application and this program is offered for insulin-treated diabetics only (which can include Type 2 depending on the severity of the disease and health care provider decision). Alberta Blue Cross defines the eligibility criterion. ‘Up to a maximum of $600 per eligible person each benefit year, that is, July 1 – June 30 for diabetic supplies purchased form a licensed pharmacy. Diabetic supplies include needles, syringes, lancets and urine and blood-glucose testing strips. There is no co-payment for eligible diabetic supplies.’ [7] This website provides the link for the application form.
The ‘health care systems costs for individuals with diabetes in Alberta in 2008 was approximately $1.2 billion…and the incident rate in Alberta increased an additional 31% between 2000 and 2010 and the number of new cases increased an additional 61%’[8]. That is significant and would definitely explain the large expenditure on this disease in that time frame.
Manitoba
The Manitoba Center for Health Policy also researches how funding should be divided in Manitoba. Manitoba looks at multiple characteristic which is unlike other provinces. They “developed a model that includes multiple characteristics of both individuals and communities using ten characteristics for hospital care, six for PCH, and eight for home care.” (University of Manitoba). “Under the federal offer made to other provinces, Manitoba would receive $18 million less from the federal government in 2017/18, and more than $1 billion less over the next ten years” (Government of Manitoba). Also, in 2017 Manitoba instituted a tariff that physicians could charge for either chronic disease management or chronic disease care per patient basis. One of these such five diseases that qualify is diabetes and the annual tariff amount is $45.00.
Manitoba has a Pharmacare program to assist individuals with the cost of their drugs and supplies if they are not covered under another program. Pharmacare coverage is based on your total family income. According to Diabetes Canada stats in 2018 report an estimated 1900.00 out of pocket expense per person is needed to cover Type 2 Diabetic medications. If you look at social security for the average senior 615.37 dollars per month (Government of Canada, 2021). Taking 1900.00 per year out of that if one has little to no income can mean someone not receiving their medications.
In February 2018, the Government of Manitoba announced the cancellation of the Special Drug Program. Those covered under this program will be transitioned to the provincial Pharmacare Program, effective April 1, 2018. - This in turn has affected thousands of people as quantities of supplies were cut back. For example, Blood glucose monitoring strips were cut back to 4 day. Thus the government was putting restrictions on someone on a budget to limit their monitoring of their Diabetes effectively.
• In October 2017, the Government of Canada announced funding for the First Nation Basic Foot
Care Program, which will provide Manitoba First Nations communities with access to improved
foot care and treatment. Over time, it will help to significantly decrease the incidence and risk
of diabetes-related foot complications.
• Effective June 2017, changes were made to Pharmacare and Employment & Income Assistance
Drug Programs benefit coverage to reduce the number of blood glucose test strips available to
individuals with diabetes. Within the new test strip policy, the maximum level of test strip
reimbursement is similar to Diabetes Canada’s minimum recommended test strip usage
guidelines. - Again, making people choose to test or not to test based on their symptoms.
• The Manitoba government launched a pediatric insulin pump program in April 2012.
Conclusion
From the numbers provided for Alberta we can see that Diabetes has a significant impact and weight on the provincial healthcare system and would suggest improvements to be made patient management as well as improved awareness of prevention implementation throughout our education systems as well as through our general health care practitioners. As our population continues to grow (we are currently at over 4 million) we cannot afford to maintain these costs in addition to our other health care demands and needs, especially when pandemics such as Sars-Cov-2 occur.
For Manitoba due to the increase aging population it would appear as though the provincial government also needs to be more proactive with health promotion and prevention. Alberta faces this same issue with the forecasted aging population rate for 2031: ‘Approximately 30% of Albertans report having at least one chronic health condition, and that number increases to over 75% if you are 65 years of age or older. It’s projected that by 2031, one in five Albertans will be a senior which will increase the demand on our health care system to manage more chronic disease.’[9]
There seems to be a trend though for both provinces in that there seems to be money going out up, down and sideways for management of the disease indicating a strong focus on management, but it would appear that equivalent efforts for preventative measures are lacking (not saying they don’t exist but the presence isn’t strong). Is it possible that perhaps T2D is becoming a cultural decision in terms of how Canada overall is choosing to live their lifestyles which in essence is leading a large portion of us winding up with T2D. How many programs will we need to "manage" this disease with our ever-growing population? The focus really needs to shift somehow to prevention. As our nation furthers in debt and our population increases I fear that for such significant "lifestyle" NCDs we will not have the money one day to keep up endless management programs, so the approach needs to shift. "Canada has one of the highest prevalence rates among OECD countries".[10] And this: ‘Diabetes shares several modifiable risk factors with other chronic diseases; these risk factors include obesity, poor diet and physical activity. An estimated 90% of diabetes cases and 60% of complications are preventable by modifying risk factors such as obesity and diet, particularly relative to countries with a low prevalence of diabetes, such as Sweden and the Netherlands. Even on indicators where Canada performs well internationally, performance is still below levels recommended by public health guidelines.’[11] From this analysis Canada really needs to step up its game.
[1] Alberta Statistics - Alberta Diabetes Link [2] Diabetes Canada – Diabetes in Manitoba [3] Ibid [4] Diabetes Program - Patient Education | Alberta Health Services [5] Diabetes Canada – Diabetes in Manitoba [6] Alberta Budget Omits Support To Albertans With Diabetes - Diabetes Canada [7] Palliative care health benefits | Alberta.ca [8] Ibid [9] Chronic Disease Management | Alberta Health Services [10] International Comparisons: A Focus on Diabetes [11] International Comparisons: A Focus on Diabetes
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