UK and insulin pumps.

[CrawleyTosser]

I think the last stats I read stated there were about 150,000 pump users in the US and about 2500 in the UK. That's not surprising given that the majority of pump users in the UK are privately funded. About three years ago I sourced my Disetronic HTron pump via eaby. It was the unused pump of a two pump set that was spare after the owner went on to a different pump. I bought it on ebay for about £300. As some will know the HTron has a time bomb that disables the pump after 18 months usage. The cost of 'servicing' in the UK is really expensive and the last quote was £450 from Roche Diagnostics who provide Disetronic pumps in the UK.

Unfortunately in the time since I got my first pump, ebay have effectively banned all auctions for medical equipment. Anecdotally speaking, I understand this is because of lobbying by the manufacturers who see a lucrative market being taken away from them. The moralists would argue that used medical equipment however reliable is a danger to the user.

In October last year my consultant put my name forward for a state-funded pump. I've seen him twice since then and now that the new financial year has started he believes I will be hearing from them very soon. The health care system in the UK is a mess. I live in an area in the south-east where the regional PCT (Primary Care Trust) is having to work in and around a massive debt. I know from experience what that means. As a pump user I did manage to get my infusions sets provided by the PCT but on the understanding I pay and then claim it back. Towards the end of my pump usage it was getting harder to get my money back from them and it took a lot of time in fax messages and phone calls.

The government published some guidelines a while ago where they told all PCT's in the country to provide pumps where the clinical need is justified by the consultant. I happen to have a really good consultant as my cut-man in the corner. I am upbeat I will get a pump quite soon as his confidence is usally muted but this recent visit he seemed quite bouyant about it. Time will tell. The short point I'm trying to make is that anyone in the UK doing MDI regimens like we all as type 1's do should contact their hospital and start lobbying for a pump. I have contributed much by way of tax and health insurance in the UK and I believe I am entitled to that and by definition I am not a revolving-door patient. You also have right to get a pump and now that the UK has finally reached a point of acceptance of the benefits of pump therapy, the time is perhaps right to send the gun-dog out to sniff around. I suggest you do so!

[Mister Q]

Good luck Crawley, what you entitled to in the UK depends so much on where you live as diff health authorities have diff rules so there is no definative answer for everyone, it is what we call in the UK the post code lottery (post code is like the US zip code).

At least 2-3 times a year a patient takes their local health authority to court to try and win treatment or medication they have been denied but which others are getting elsewhere.

As an aside why are there so many less pump users in the UK comapred to the US?

[CrawleyTosser]

As an aside why are there so many less pump users in the UK comapred to the US?

In the US I believe that there are many private health schemes that firms can register with and with that the benefits can vary from one scheme to another? I've also read somewhere that the health care providers negotiate with the pump suppliers for better deals. Minimed (Medtronic) have about 75% market share in the US while Disetronic have the same in Europe. A sort of turf-war perhaps? I understand that health insurance is expensive in the US. For our 'foreign' members, the UK has a noble system with the concept of the NHS of free-care-for-all but indirectly it's funded by taxes. Pump therapy is not mainstream yet. In fact in Crawley, there was myself and a young T1 girl who were the only pump users in a town population of 120,000. Go figure!

Yes, the post-code lottery is an issue. When I got my pump I 'transferred' to Bournemouth Hospital for training and three month care as that is the most progressive PCT in the country and they have something like 200 pump users and their consultants and DSN's are very pro-active in getting funding. When I was on the pump my BM's and A1C were absolutely in the groove, something I've now lost since I went back to injections. Considering that the government here totally screwed up by overspending on GP contracts by some £70m; wasted £700m on the Millenium Dome; overspent by £400m on the air traffic control system; wasted £1.5b on a pension system and they spent £300m on a system to unify customs revenue and inland revenue collections and wait for it, the system was so complex to use that in three years C&E did precisely two transactions at a cost of £150m each. I guess with figures like that why should they 'waste' pennies on insulin pumps when there are more deserving causes? (rolleyes).

I don't know what the state of Manchester is but we have an MP in Crawley, Laura Moffett, who is one of the most inept politicians I have ever spoken to and is real yes-person. She has little intellect (in keeping with the average in the town) and as a former nurse she was utterly toothless when it came to saving our local hospital. I mention this because you might want to arrange a visit to your MP's weekly surgery to discuss pumps and see if the MP can help. Unfortunately, our MP is a tosser-deluxe. When the Prime Minister went in for a piles operation they were afraid to operate in case they cut off Laura Moffet's head.

[Mister Q]

In the US I believe that there are many private health schemes that firms can register with and with that the benefits can vary from one scheme to another? I've also read somewhere that the health care providers negotiate with the pump suppliers for better deals. Minimed (Medtronic) have about 75% market share in the US while Disetronic have the same in Europe. A sort of turf-war perhaps? I understand that health insurance is expensive in the US. For our 'foreign' members, the UK has a noble system with the concept of the NHS of free-care-for-all but indirectly it's funded by taxes. Pump therapy is not mainstream yet. In fact in Crawley, there was myself and a young T1 girl who were the only pump users in a town population of 120,000. Go figure!

Yes, the post-code lottery is an issue. When I got my pump I 'transferred' to Bournemouth Hospital for training and three month care as that is the most progressive PCT in the country and they have something like 200 pump users and their consultants and DSN's are very pro-active in getting funding. When I was on the pump my BM's and A1C were absolutely in the groove, something I've now lost since I went back to injections. Considering that the government here totally screwed up by overspending on GP contracts by some £70m; wasted £700m on the Millenium Dome; overspent by £400m on the air traffic control system; wasted £1.5b on a pension system and they spent £300m on a system to unify customs revenue and inland revenue collections and wait for it, the system was so complex to use that in three years C&E did precisely two transactions at a cost of £150m each. I guess with figures like that why should they 'waste' pennies on insulin pumps when there are more deserving causes? (rolleyes).

I don't know what the state of Manchester is but we have an MP in Crawley, Laura Moffett, who is one of the most inept politicians I have ever spoken to and is real yes-person. She has little intellect (in keeping with the average in the town) and as a former nurse she was utterly toothless when it came to saving our local hospital. I mention this because you might want to arrange a visit to your MP's weekly surgery to discuss pumps and see if the MP can help. Unfortunately, our MP is a tosser-deluxe. When the Prime Minister went in for a piles operation they were afraid to operate in case they cut off Laura Moffet's head.

The best way I can describe the state of things these days here in the UK, I work with a guy who emigrated here several years ago from the Middle East, a few months back he procalimed this country as 'buggered' - I thought that says it all even the immigrants are leaving!!

Having said that some people die in the world for a lack of clean water or food, so I guess we are not the best but no-where near the worse.

Politico's - Wouldn't p**s on 99% of them if they burst into flames, they are mostly on a massive ego trip or a huge gravy train, thats in my humble opinion of course.

[JediSkipdogg]

Personally, this forum has taught me alot about health care that I never knew before. In my eyes, the best health care would be one that is 50% government funded and 50% private funded. In the US that will never fly because our current president doesn't believe government should interact with private business unless it's to make a huge profit for them (ie. oil companys.)

I think every country has a little piece of a gold solution to the ultimate health care system. The system should be run that governmental health care should pay for office visits and checkups, and then private insurance should pay, without arguing, for all prescriptions and medical devices. The problem is that although the public would be healthier, from annual free governmental checkups, insurance rates for supplies for those with a medical condition would be sky high since they wouldn't have people paying into the system that order no supplies. So I guess that idea is shot.

Just keep pressing the issue for a pump. Hopefully one day you can be approved for a true working one. Oh, and eBay, it wasn't the companies that didn't want that to happen, it's that it was illegal and the FDA demanded it stop, since in the US pumps are a prescription only item, and well, on eBay, no prescription required.

[DeusXM]

Actually as far as I'm aware there are set standard for whether you're eligible for a pump in the UK. They are:

Inability to maintain well-controlled BG with intensive insulin therapy
Frequent episodes of hypoglycaemia
Having extended a range of insulin options
Demonstrating a confident understanding of the relationship between your insulin and what you eat, say, having completed a DAFNE course

When I was changing back to Lantus I was told I was eligible for a pump given that I was hypoing all the time on Insulatard, Levemir didn't work for me and Lantus screwed with my brain.

For all the bad talk about the NHS, I wouldn't change it for the world. I love the fact I can get as many test strips as I want, as much insulin as I need, and get insulin pens just by asking for them, without having to pay a penny.

The reason the NHS is reluctant to fund pumps is because it's perfectly possible to get great control on MDI, which is far cheaper than a pump. It's a simple cost-to-benefit ratio.

If you really want a pump and you're not an NHS candidate, then like the Americans you can pay for your own pump through your health insurance. Without wanting to sound harsh, there is simply nothing stopping you getting a pump if you want one. But that's why there are fewer pump users in the UK than in the US. It's got nothing to do with the quality of care - it's because we in Britain now regard the idea of paying for healthcare as an alien concept.

[Mister Q]

The NHS is by no means perfect but its the best we have got, some American friends were green with envy about our 'socialised medicence system' as they call it. Sure as Deus says there are upsides, I get all my meds and testing strips free, not only diabetic meds but all meds, however if you are not exempt then you pay around Six pounds sixty five pence (over 12 US dollars) for a prescripion and thats per item on the prescription 3 lots of meds is 3 x 6.65, unless you live in Wales where that amount has now dropped the 3 pounds and will become free in 2007.

My diabetes was picked up as a result of an Op to cut out a cyst in the middle of my chest that would not heal, I was quoted 18 months on the NHS to have looked at as it was deemed low priority by the NHS, luckilly I am covered by private medical insurance with my employer so could get it done much quicker.
So some things are stretched beyond belief in the NHS, the dentist situation is now so bad here if an new NHS dentist opens for business then people queue worse than for World Cup or Superbolw final tickets to join - and then you still have to pay to get treated, just not as much as a private dentist.

But like I said above we are by no means the worse off, who knows what the ideal solution is Fascism and communism have come been and gone and they didnt work, so whats next?

[CrawleyTosser]

...If you really want a pump and you're not an NHS candidate, then like the Americans you can pay for your own pump through your health insurance...

My employer covers us through private medical insurance but there are very strict regulations imposed that long-term chronic conditions, like diabetes, are not covered so that plants reponsibility back on to the NHS patch. Pumps in the UK are very expensive, about £2500. On top of that, my consultant had to fight my corner getting infusions sets paid for and those rack up to about £150 a month if you are not eligible to qualify. In the beginning I used to source my infusions sets via ebay and I got some real bargains.

I try not to be too cynical but the price of the pumps of most of the manufacturers is very close to each other and I wonder if there is a cartel involved? Perish the thought, they would not act like that, would they?

[Funnygrl]

Pumps in the UK are very expensive, about £2500. On top of that, my consultant had to fight my corner getting infusions sets paid for and those rack up to about £150 a month if you are not eligible to qualify.

That's actually cheaper than they are in the US. My pump cost my insurance $7,000 (aprx. 3,800 pounds). My infusion sets are cheaper than 150 pounds though, at $150 (around 80 pounds).

[DeusXM]

My employer covers us through private medical insurance but there are very strict regulations imposed that long-term chronic conditions, like diabetes, are not covered so that plants reponsibility back on to the NHS patch.

It's no different in the United States. Talk to those here from the US who didn't have health insurance when they got diagnosed with diabetes and how tough they've found it.

So some things are stretched beyond belief in the NHS, the dentist situation is now so bad here if an new NHS dentist opens for business then people queue worse than for World Cup or Superbolw final tickets to join - and then you still have to pay to get treated, just not as much as a private dentist.

A lot less. I used to have a private dentist who charged £80 to see you. I now get to see an NHS dentist for £15. Given that I hardly use dentistry services (22 years old and not a single filling), I'm happy with my arrangement.

Granted, the NHS could be a lot better, but it could also be a lot, lot worse.

[Ailsa]

[QUOTE][That's actually cheaper than they are in the US. My pump cost my insurance $7,000 (aprx. 3,800 pounds). My infusion sets are cheaper than 150 pounds though, at $150 (around 80 pounds).
/QUOTE]

I have thought pumps sound expensive in the US & wonder if the companies selling them jack up the price since the insurance is paying.
Here they cost $NZ 7,500 - $8,000 which would be about $US 4,500
Consumables are about $2,500 or $US 125 per month.

No way you can get insurance to pay here ever. Same with dental treatment which costs a lot, but I believe major work is heaps cheaper than the US. In fact I know Kiwis who come home to get it done & save the price of the trip.

[condensr]

My pump was BILLED to the insurance at $6000.00, but the insurance is only going to have to pay $4049.65. That is the contracted price, and I won't have to cover anything outside of that.

[notme]

I would think some of the difference between the two countries would be population. US has approximately 296 million people where the UK has 63 million. That being said, I also believe that pump therapy will result in healthier people with diabetes. Since starting the pump five and a half years ago, my numbers have decreased dramatically. I think if a doctor thinks you would benefit from pump therapy, then it should be supplied.

US has its healthcare issues, just like many other countries. The difference here is the poor, go uninsured. At least in countries with socialized medicine, there is healthcare for the poor.

[Tim_Roy]

Well, as far as the U.S. goes, if S.1955 passes, a lot of us could lose our diabetes supplies coverage.

And I understand the West Side of Staines has an excellent MP.