4
VOLUME 10 NUMBER 1 • MARCH 2013
FUNDING DIABETES CARE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Correspondence to:
Discovery Health
Website:
S Afr J Diabetes Vasc Dis
2013;
10
: 4–6
Managing the world’s number one chronic disease:
a healthcare funder’s perspective
DISCOVERY HEALTH
D
iscovery Health provides a funder’s perspective on the
management of diabetes. The Discovery Health Medical
Scheme is South Africa’s largest open medical scheme.
Impact of chronic diseases of lifestyle
Chronic diseases of lifestyle have rapidly snowballed into a global
epidemic and are a leading cause of death and disability worldwide.
The prevalence of chronic diseases is on a steep trajectory, with
predictions that chronic diseases will be responsible for up to 73%
of all deaths and 60% of the global disease burden by 2020.
1
Type 1 and 2 diabetes mellitus are two of these many chronic
diseases. Type 1 diabetes is an autoimmune disease that represents
5% of the population with diabetes, resulting from the body’s
destruction of the pancreatic cells that produce insulin. On the
other hand, type 2 diabetes is a chronic disease linked to poor
lifestyle choices, including obesity, high cholesterol levels and
physical inactivity; as well as a genetic predisposition to inheriting
the disease. Type 2 diabetes accounts for 95% of all diabetes.
2
International Diabetes Federation (IDF) statistics reflect there
are 371 million people worldwide who have been diagnosed with
diabetes and are living with the ill effects of the disease.
2
It is also
estimated that there are 187 million people worldwide who are
unaware that they have diabetes. The IDF estimates that by 2030,
there will be 552 million people worldwide living with diabetes,
with the bulk of these people located in emerging economies.
In South Africa, the Johannesburg-based Centre for Diabetes
and Endocrinology approximates the number of South Africans
diagnosed with diabetes at 3.5 million, with about 5 million more
who are unaware that they have the disease.
3
Economic costs of chronic diseases
The high number of chronic diseases of lifestyle will continue
to place an increasing burden on government and healthcare
facilities in the years to come. This is particularly relevant as
regions and industries are increasingly battling to address the
high cost of healthcare and its impact on economic growth and
human resource management. While many of these diseases can
be avoided through preventative healthcare measures, the rising
burden of chronic diseases worldwide presents a funding challenge
for many healthcare funders. Globally, the cost of funding chronic
diseases of lifestyle is expected to reach over $47 trillion by 2030,
a massive financial burden.
4
For healthcare funders, this high cost poses significant
challenges. These include the increasing disease burden and
benefit utilisation of a membership base, the high costs of
medical technologies and the high utilisation of expensive
technology. At the same time, healthcare funders must manage
resources responsibly and maintain affordable premiums to
ensure sustainability and financial protection for members. These
challenges provide a natural tension in how healthcare resources
are managed, and funding decisions must therefore be made with
the interests of all stakeholders at heart.
In light of the growing chronic diseases epidemic, Discovery
Health’s role as the largest healthcare funder in South Africa is to
fund healthcare of the highest quality for our members. Discovery
Health has consistently increased its funding of chronic disease
medication each year, from R1.08 billion to R1.74 billion in 2012.
In 2012, 325 157 Discovery Health members were registered with
chronic diseases. Of this number, a total of 79 838 members were
diagnosed with type 1 and 2 diabetes. At Discovery Health, diabetes
mellitus accounts for 14.41% of the total patients registered on the
chronic illness benefit (CIB), and represents 13.49% of the costs.
Table 1 and Fig. 1 show a comparison between the cumulative
increase of all claims made by Discovery Health members with
chronic diseases and members with chronic diabetes per 1 000
members during the period 2008 to 2012. The number of claims
made by chronic members increased from 11.54 per 1 000
claimants in 2008 to 13.55 per 1 000 in 2012, while the number
of claims made by chronic diabetics increased from 1.58 per 1 000
claimants in 2008 to 1.95 per 1 000 in 2012.
Table 1 and Fig. 1 show how, during the same period ending
in 2012, those with diabetes made 6% more claims than other
chronic members. This reflects how diabetes is increasing across all
demographics, making it the world’s number one chronic disease,
for which healthcare funders need to fund treatment.
How Discovery Health funds medication for chronic
diseases
As a medical scheme that manages funds for members, Discovery
Health embraces new technology that is of proven benefit to our
members in a responsible manner, taking into consideration the
Table 1.
Cumulative increase of all chronic diabetics vs all chronic members
from 2008.
Year
All chronic
claimants
per
1 000 lives
All diabetic
claimants
per
1 000 lives
Cumulative
increase:
all chronic
claimants (%)
Cumulative
increase: all
chronic diabetics
(%)
2008
11.54
1.58
100
100
2009
12.01
1.63
104
103
2010
12.68
1.74
110
110
2011
13.15
1.85
114
117
2012
13.55
1.95
117
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