In health care, the bill always comes due one way or another

There can be few better indicators of the staggering costs of a lack of access to affordable health care than Georgia’s current crisis in a familiar and potentially deadly disease: diabetes.

A recently released medical study by Emory University shows that the sole treatment site for an increasing number of diabetic Georgians is the one where far too many uninsured people nationwide get the only care they receive for any medical problem — the emergency room.

This is for a condition that in most cases could have been managed with medication and lifestyle changes, and that by the time it reaches the ER stage may well have progressed to a dangerous, even life-threatening level of severity.

Not surprisingly, the Emory study shows, the highest rates of ER visits for diabetes are in chronically poor rural central, south and northwest Georgia.

Jean O’Connor of the state Department of Public Health told Georgia Health News that about 44,000 Georgians are diagnosed with diabetes each year, a rate she called an “epidemic.” That rise, she said, is part of a national trend of more Americans being overweight.

But Georgia outpaces the nation in an unenviable category: Georgia Health News cites Centers for Disease Control statistics showing that the prevalence of Georgia adults with diabetes is 20 percent higher than the national average. O’Connor of Public Health told GHN the annual health care cost of diabetes in Georgia exceeds $5 billion. Georgia has one of the nation’s highest rates of people without health insurance. Those facts can’t possibly be coincidental.

Obesity, in developed countries like the U.S., can actually be a poverty indicator, as counterintuitive as that might be on the surface. Emory epidemiologist Shivani Patel, who co-authored the diabetes study, said areas with high levels of poverty, housing problems and unemployment also tend to have less access to affordable healthy foods — and higher rates of hospitalization for diabetes.

“All of these factors — social conditions, unhealthy food environments and poor quality of care — are problems in rural areas,’’ Patel told GHN.

All of which underscores the urgency of efforts like those of, among others, state Sen. Renee Unterman, R-Buford, to urge the state to rethink its resistance to expanding Medicaid under the Affordable Care Act. Until Congress replaces or revises ACA (or simply scraps it), it’s a source of federal money that could fund preventive and maintenance care to make a lot of these expensive (to taxpayers) ER visits unnecessary.

“When you don’t have health insurance, you don’t see a primary care physician,’’ Carly Benton, director of Mercy Ministries charitable health clinic in Lyons, told GHN. “You can’t afford medication.”

O’Connor — whose role at the Department of Public Health is that of chronic disease prevention director — echoed Benton’s lament. Diabetes “should be managed in a primary care setting,” she said. In terms of access to such care, she added, “any hospitalization shows something is off.”

This story was originally published November 2, 2017 at 4:48 PM with the headline "In health care, the bill always comes due one way or another."