美国国家公共电台 NPR It's Not Just Insulin: Diabetes Patients Struggle To Get Crucial Supplies

 

RACHEL MARTIN, HOST:

The surging price of insulin has become a rallying cry for health activists¹, but people with diabetes² also need other crucial medical supplies, and insurance rules can make getting those an unexpected challenge. Here's Bram Sable-Smith.

BRAM SABLE-SMITH, BYLINE³: Managing Type 1 diabetes is about managing blood sugar. If it gets too low, patients risk sudden seizures⁴ and loss of consciousness; too high and they risk long-term effects, like vision loss, nerve damage and even limb amputation⁵. Ric Peralta knows these risks well.

RIC PERALTA: I speak very openly about my blood sugar.

SABLE-SMITH: Peralta spent years checking his blood sugar by drying drops of blood from his fingertips and placing them on a device called a glucose⁶ meter. Doctors suggest doing this four to 10 times a day, but that can leave even the most diligent⁷ testers with large gaps in knowledge about what their sugars are doing.

PERALTA: I didn't realize that I had rather severe peaks and valleys happening in between my mealtimes.

SABLE-SMITH: An optician in Whittier, Calif., Peralta says everything changed last year when one of his patients told him about something called a continuous glucose monitor. It's a small device patients can easily insert under their skin for 10 days that gives accurate blood sugar readings every five minutes or 288 times every day. Peralta called up Dexcom, one of a few continuous glucose monitor makers⁸, and within two weeks, he had the system on his doorstep.

PERALTA: I still didn't even 100% appreciate exactly how it was going to change my life. It was amazing.

SABLE-SMITH: In the first three months, he lowered his average blood sugar by three percentage points. When he took his family on road trips, he used to worry his blood sugar would get so low without his realizing that he'd pass out while driving. Now...

PERALTA: Hey, Siri, what's my sugar?

SABLE-SMITH: ...He can just ask Siri.

SIRI: Dexcom G6 says you're 134 and steady.

SABLE-SMITH: But for Peralta, the problems started when it came time to refill his supplies. The continuous glucose monitor has three parts - the sensor⁹ you stick under your skin and also a transmitter and a receiver. Each one requires something called prior authorization¹⁰. It's a rule from his insurance company that requires his physician to seek approval from insurance to prescribe the device. And while his sensor needs authorization every three months, the transmitter gets it every six months and the receiver, once a year.

PERALTA: Yeah, it's exhausting to deal with.

SABLE-SMITH: Once, the authorization requests for Peralta's sensor and transmitter got bundled together by mistake and the whole order got denied and delayed. He says this kind of mix-up happens a lot.

PERALTA: I've gone at least a month or longer without having any kind of Dexcom unit and having to go back to the old finger prick¹¹.

SABLE-SMITH: Kate Berry's with America's Health Insurance Plans, a lobbying and trade group. She says insurers use prior authorizations to guard against large variations in how doctors prescribe.

KATE BERRY: Prior authorizations are in place to protect patients, to improve safety.

SABLE-SMITH: She says insurers have identified five ways to improve the process, but in a recent survey of 1,000 doctors, 91% said prior authorizations have a negative impact on the health outcome of their patients. And endocrinologists like Scott Isaacs, whose specialty¹² includes diabetes, say doctors are getting increasingly frustrated¹³.

SCOTT ISAACS: It's a huge burden for the doctor as well, and they have no way of billing for the time it takes to do these prior authorizations.

SABLE-SMITH: But for Ric Peralta, keeping track is not just a bureaucratic¹⁴ headache. It's a matter of survival.

PERALTA: If I do not have my proper management of this disease, I'm going to die from it. And they're making it as difficult as possible. And it's really frustrating¹⁵.

SABLE-SMITH: Frustrating because he knows this technology can change lives but only if patients can depend on their supply. For NPR News, I'm Bram Sable-Smith in Madison, Wis.

(SOUNDBITE OF SUN GLITTERS' "WHAT ARE WE WAITING FOR")

MARTIN: That story is from a reporting partnership¹⁶ between NPR and Kaiser Health News.

1 activists   

n.（政治活动的）积极分子，活动家( activist的名词复数 )

参考例句：

• His research work was attacked by animal rights activists . 他的研究受到了动物权益维护者的抨击。
• Party activists with lower middle class pedigrees are numerous. 党的激进分子中有很多出身于中产阶级下层。 来自《简明英汉词典》

2 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 seizures   

n.起获( seizure的名词复数 )；没收；充公；起获的赃物

参考例句：

• Seizures of illicit drugs have increased by 30% this year. 今年违禁药品的扣押增长了30%。 来自《简明英汉词典》
• Other causes of unconsciousness predisposing to aspiration lung abscess are convulsive seizures. 造成吸入性肺脓肿昏迷的其他原因，有惊厥发作。 来自辞典例句

5 amputation   

n.截肢

参考例句：

• In ancient India,adultery was punished by amputation of the nose.在古代印度，通奸要受到剖鼻的处罚。
• He lived only hours after the amputation.截肢后，他只活了几个小时。

6 glucose   

n.葡萄糖

参考例句：

• I gave him an extra dose of glucose to pep him up.我给他多注射了一剂葡萄糖以增强他的活力。
• The doctor injected glucose into his patient's veins.医生将葡萄糖注入病人的静脉。

7 diligent   

adj.勤勉的，勤奋的

参考例句：

• He is the more diligent of the two boys.他是这两个男孩中较用功的一个。
• She is diligent and keeps herself busy all the time.她真勤快，一会儿也不闲着。

8 makers   

n.制造者，制造商（maker的复数形式）

参考例句：

• The makers of the product assured us that there had been no sacrifice of quality. 这一产品的制造商向我们保证说他们没有牺牲质量。
• The makers are about to launch out a new product. 制造商们马上要生产一种新产品。 来自《简明英汉词典》

9 sensor   

n.传感器，探测设备，感觉器（官）

参考例句：

• The temperature sensor is enclosed in a protective well.温度传感器密封在保护套管中。
• He plugged the sensor into a outlet.他把传感器插进电源插座。

10 authorization   

n.授权，委任状

参考例句：

• Anglers are required to obtain prior authorization from the park keeper.垂钓者必须事先得到公园管理者的许可。
• You cannot take a day off without authorization.未经批准你不得休假。

11 prick   

v.刺伤，刺痛，刺孔；n.刺伤，刺痛

参考例句：

• He felt a sharp prick when he stepped on an upturned nail.当他踩在一个尖朝上的钉子上时，他感到剧烈的疼痛。
• He burst the balloon with a prick of the pin.他用针一戳，气球就爆了。

12 specialty   

n.(speciality)特性，特质；专业，专长

参考例句：

• Shell carvings are a specialty of the town.贝雕是该城的特产。
• His specialty is English literature.他的专业是英国文学。

13 frustrated   

adj.挫败的，失意的，泄气的v.使不成功( frustrate的过去式和过去分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's very easy to get frustrated in this job. 这个工作很容易令人懊恼。
• The bad weather frustrated all our hopes of going out. 恶劣的天气破坏了我们出行的愿望。 来自《简明英汉词典》

14 bureaucratic   

adj.官僚的，繁文缛节的

参考例句：

• The sweat of labour washed away his bureaucratic airs.劳动的汗水冲掉了他身上的官气。
• In this company you have to go through complex bureaucratic procedures just to get a new pencil.在这个公司里即使是领一支新铅笔，也必须通过繁琐的手续。

15 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

16 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。