Gesundheitsökonomik und soziale Frage

Bei meiner Erkundung von Facebook stieß ich an der Pinnwand der Diabetes-Gruppe auf die Frage einer Wirtschafts-Studentin, die sich danach erkundigte, wieviel man bereit wäre, für eine Insulinpumpe zu zahlen, wenn man keine Krankenversicherung hätte? Bekanntlich stellen Ökonomen immer die falschen Fragen, wie Kurt Tucholsky in seinem „Kurzen Abriß der Nationalökonomie“ bereits ausgeführt hatte. Ich schrieb dort also am 27., 28. und 29. Oktober 2009:

Alyssa, in Germany insulin pumps are provided by public and private health insurance companies provided certain conditions are met (you have to demonstrate that you have been able to treat your diabetes with insulin pens for awhile by presenting your diabetes diary). AFAIK, there is no additonal charge that would keep you from using a pump. Over 90% of Germans are members of public health insurance which provides everything that is necessary for treating the disease. This is also true for the poor and for the unemployed. So the question how much you would pay for a pump is all but impossible to say because it is completely hypothetical.

Auf Nachfrage: „Thank you for the responses. completely hypothetical is what I am looking for. …“. Sie weiß also durchaus, daß ihre Frage mit der sozialen Wirklichkeit nicht viel zu tun hat.

Alyssa, I think the point is not what I would be willing to pay, but rather what I would be able to pay for an insulin pump. This makes a great difference, depending on your income etc. And then, you don’t switch from pens to a pump for fun, it’s rather a necessity. A pump will be chosen instead of a pen, e.g., if you suffer from high glucose levels at dawn that cannot be lowered otherwise.

So I would differentiate between two scenarios if I had no medical coverage: (1) If I was rich, I would pay for what I need. Period. I cannot say an exact sum of money because I have no idea what it would take to buy or lease an insulin pump for the rest of my life. It would be an investment in my health. (2) If I was poor and I could not afford it, although I needed a pump for medical reasons, the question, again, would be „completely hypothetical“. In this case a pump would just not be available to me.

BTW, the new continuous glucose meters that have become available lately are another case in point. It’s just the same with them. Health insurers pay for them only if there is a medical indication….

Daraufhin wandte man aus den USA ein: „Not free in the U.S.! You either pay for insurance and hope it is covered or pay out of pocket but anyone who wants one could get one. I’ve been on pens my whole life and very well controlled. I wouldn’t, at this point pay $5,000 plus supplies for a pump even though we could afford it. If my health started to deteriorate, I would consider it only because we could find the money but for those who can barely afford insulin it wouldn’t even be an option.“

There is one more thing you might like to consider, Alyssa. As I already mentioned, insulin pumps are not bought in this country, but they are leased for some years by a public health insurer. I would like to dwell on this point because it is important in economic terms, too. It means that if the pump you get fails it will be replaced with no additional fee by the manufacturer within a day or so. There is a guarantee that a replacement will be avilable for some years (as long as the contract runs). OTOH, I understand that patients cannot easily switch from one pump to another.

Barb makes an important point, I think. I understand that health insurance in the U.S. is very bad. I just do not understand that people do not seem to care very much about this situation, considering the recent protests against Obama’s plans to introduce some kind of public health insurance as we know it in Europe.

If you can „barely afford insulin“ a pump is indeed a piece of luxury. What’s more, I have been told at the hospital that we use different sorts of insulin (insulin analogs) in Europe that are a bit more expensive than what is used in the U.S. as a standard therapy. This makes life so much easier. It is also employed in pumps. I think it would be a first step to have patients supplied with up-to-date insulins in the first place.