A few people have asked me about the health system here in Australia and I though that it would be a good idea to describe the reality that people living with D face in this country.
First of all, I must say that I’m in no way expert of the how the health system works in the US or in other countries, so whatever comparisons I make here are based purely on my limited knowledge and personal experience. These comparisons can and are destined to be wrong from time to time. If you find one of these inaccuracies, please help me by leaving a comment so I can correct it.
Insulin and other drugs.
Insulin is a prescription drug in Australia. This means that to be able to buy it, you need to see a doctor. The good news is that any General Practitioner (Australian for primary care doctor) can provide a prescription for insulin. I’m not too familiar with the prescription status of other diabetes drugs, but I would be surprised if it is much different.
The next thing to mention is that Australia has a publicly funded health services scheme called Medicare (you could think of it as public health insurance). This covers all citizens, permanent residents and visitors from certain countries with whom Australia has special reciprocal agreements.
Part of the benefits of Medicare is the Pharmaceutical Benefits Scheme (commonly known as PBS), which subsidises most prescription medicines. In the case of insulin, this means that we pay A$32.90 (approximately US$25 or 20 euro) for 5 vials of 10ml each or 5 boxes of pens (5 pens in each box). People on unemployment benefits or other forms of welfare may pay even less than that.
But of course insulin is not the only thing that people with diabetes need to stay healthy. But luckily, there is also a program to cover these additional supplies. The program is called National Diabetes Services Scheme (NDSS) and is administered by our local diabetes association, Diabetes Australia.
The NDSS delivers a variety of diabetes related products, including test strips, syringes or pen needles, etc. As an example, most test strips cost A$14.10 (US$11) per box of 100 and syringes are completely free.
Insulin pumps are a slightly more complicated business. Neither Medicare nor the other government schemes pays for the initial cost of insulin pumps (although a small subsidy is available for some children). That said, private health insurers are required by law to cover the cost of getting a pump. For many of us, this means that after 12 months of getting our own private health insurance we can get a pump at no extra cost. With the cost of these little marvels in the order of around $8000 this is a great relief.
In terms of the ongoing supplies needed for the pump, the NDSS covers these, but only for people with Type 1 diabetes and within certain guidelines (relatively easy to meet if you have type 1). Once you have been approved by your endocrinologist of certified diabetes educator, you can get access to pump consumables, again, at subsidised prices. I personally pay A$9.30 (US$7) per box of 10 reservoirs, and infusion sets cost around A$1.5 each
Overall, the system here is very supportive, but also somehow inflexible. There is, for example, no coverage at all for Continuous Glucose Monitoring, and getting new subsidised products involve lengthy negotiations with the government which tends to slow down the process significantly.