# The \$18,000,000 question

I have a question for the readers…what would you do with \$18,000,000?

There’s a method to my madness (no comments from the peanut gallery), but I first need to provide some background information.

Diabetes is an increasingly common medical condition both within our state as well as across our nation.

The current estimate, by the World Health Organization, is that approximately 9% of the adult population has diabetes.

The CDC suggests that this number is higher as more than a quarter of the population has high sugar readings, but not yet diagnosed with diabetes.

According to the American Diabetes Association, diabetes remains the 7th leading cause of death in the United States (based on 2010 data). The complications of diabetes are extensive and include things such as disability and death from heart disease and strokes, not to mention life-impacting complications such as kidney disease, amputations, blinding, nerve damage and blindness. This is kind of a bad thing to get if you catch my drift.

I’d like you to take a little math journey with me, one that will lead to some very interesting numbers.

Using the number of 1.3 million citizens in the State of Maine, let’s assume for a moment that 10% of the Maine citizens have the diagnosis of diabetes (a gross underestimate when you read the Maine CDC report).

Physicians and other healthcare professionals use a test called a hemoglobin A1c to help monitor treatment for diabetes…it’s an average of what a patient’s daily blood sugar level is. Typically this is done at least twice a year, sometimes every 3 months after the diagnosis of diabetes is made to ensure that the treatment that has been started is actually working.

Let’s run some numbers and, to be fair, let’s be very conservative.  Let’s assume that each of the approximately 130,000 diabetics in Maine only have this test done once a year.  That would equal 130,000 tests a year.

Hospitals are big organization with huge purchasing power, so let’s cruise on over to the Maine Health Data Organization and see what the state average total cost for a hemoglobin A1c is…\$147.81. Let’s use \$150 to keep the math simple and straight-forward.

So 130,000 tests multiplied by \$150 per test = \$19,500,000 per year for one test for one medical condition.

That’s a huge chunk of change and a lot of Awful Awfuls

Let’s compare that to some other numbers.

As a solo family physician, I don’t have a great deal of purchasing power in comparison to the large healthcare organization in our state, but despite this, I’ve been able to secure a price (using free-market principles) of \$10 for this test…yes, that’s right…\$10.

So, using the same number of patients:

130,000 patients multiplied by \$10 per test = \$1,300,000 per year. That, my friends is a total savings of \$18,200,000 per year!

So, what would I do with \$18,200,000?  I have some ideas, but I’d love to hear yours!