In a time when the insulin price crisis in America has become a such prominent news story, it’s easy to lose sight of the global scope of the issue. The same three big pharmaceutical companies that dominate the American market control the world market as well. Wildly varying national health, drug and insurance policies make for wildly varying insulin prices. Add entirely different economic climates, and it becomes clear that the affordability of diabetes supplies differs extraordinarily from one country to another.
Enter the 2018 T1International Patient Survey (PDF). An attempt to gauge global insulin affordability and the extent of rationing, the report shows that “a worryingly high number of people with Type 1 diabetes are subject to life-threatening rationing due to financial costs.” T1International is a non-profit that advocates for worldwide access to insulin and diabetes supplies, and the organization hopes that these new statistics will help elucidate the challenges it and its allies face.
The United States in Context
The organization’s analysis sheds light on America’s performance in comparison to two other broad groups: high income (e.g. Germany, Japan, Australia) and low/middle income (e.g. India, Ecuador, Peru). The U.S. is, of course, comfortably categorized as a high income nation, but generally speaking, it performs more like a low/middle income nation.
Of the more than 600 American survey respondents, 25.9% reported rationing or foregoing insulin sometime in the last year. This rate was even higher than that of the low/middle income countries (22.3%), and was nowhere close to the far lower rate of the other high income countries (a mere 6.5%). The U.S. has “by far the highest insulin rationing of any high income country.”
In addition, 32.4% of those from high-income countries reported that they had full health coverage and paid nothing out of pocket. Again, the U.S. (6.5%) and in the low/middle income countries (6.2%) performed similarly.
It is difficult to generalize about the low/middle income category, which takes in an extremely large and diverse group of countries, many of which had as few as just one respondent in the survey – these included nations such as Yemen and Rwanda. As poorly as the United States performed, among people with diabetes in some of the world’s less prosperous countries face, an astonishing 45.6% of those reported that they had absolutely no coverage for their costs – a claim that only 4.3% of Americans made.
An effort was made to make the survey available to those without ready internet access; some respondents filled out their answers with pen and paper, facilitated by T1International’s partner organizations. But the survey would invariably have been most visible to motivated participants of the diabetes online community, and responses were clustered mostly in high income nations, which suggests that the numbers dramatically understate the extent of global insulin rationing. An executive summary notes that “it has been reported that one out of every two people globally in need of insulin cannot access or afford it.”
A webpage accompanying the report offers maps and sortable data. Users can also read the comments of respondents, some of which provide harrowing anecdotal evidence of the dire straits that some people with T1D face.