Overview
Uruguay has an Integrated National Health System. The system provides medical coverage through the National Health Insurance, “Seguro Nacional de Salud” (SNS), to both workers and retired people, as beneficiaries for their current or previous activity. There is also Private Health Insurance companies that charge for consumables according to the co-payment price, deals with different labs, etc.
Beneficiaries of SNS get medical coverage for their families. This includes children, under 18 years old or older with disabilities, their spouse or cohabiting partner who does not have medical coverage and 3 or more dependent children. The SNS is financed by the National Health Fund, “Fondo Nacional de Salud” (FONASA), which is constituted in the Social Insurance Bank of Uruguay. The BPS is the agency who makes the payment to the entities that provide health services.
What happens if you need to see a doctor?
If you need to see a doctor, you must schedule a consultation. If you need to see a specialist, like a diabetes doctor (endocrinologist), it might take several weeks after the request to be processed and to get an appointment.
Who decides what doctors can prescribe?
The Ministry of Public Health (MSP) holds a record of allowed medications in the country which are enlisted in the “Formulario Terapéutico de Medicamentos“ (FTM). All medical health professionals have the right to prescribe medication.
Practically, what is it like to live with type 1 diabetes in Uruguay?
All people living with type 1 diabetes in Uruguay are treated by public health providers and have access to supplies for their diabetes care. These supplies include test strips and NPH insulin. There is a diabetes law in Uruguay that states that certain medications, including NPH and Regular insulin, are tax exempt and have no cost.
With respect to analogue insulin, there is a charge for them according to the co-payment price of the different private insurance providers. Test strips cost between 90 and 280 Uruguayan pesos (3 to 9 USD) for 25 strips, depending on the provider. Long acting analogue insulins otherwise have a high cost if they are purchased outside the health service. The price varies between 600 and 800 Uruguayan pesos (17 to 25 USD).
In the case of long acting analogue insulin like Lantus and Levemir, there is an option where the National Fund of Resources (FNR) will provide it at no cost. In order to have this benefit, an application must be submitted to the FNR by the specialist treating the patient. It will state the patient’s need of the drug, and then the case is evaluated by a committee of the FNR to check eligibility. It should be noted that the majority of people with type 1 diabetes do not have access to the benefit of the FNR.
The biggest challenges in Uruguay with type 1 diabetes are access to quality medication and new technologies for the treatment of diabetes, as well as the lack of education in the management and the care of diabetes in society. The new insulins are usually not available in our market. Furthermore, there is a lack of technologies like continuous glucose monitoring (CGM) and insulin pump therapy (IPT). There is only one company that sells the technology at a very high price which is not affordable for people with diabetes.
CGM and IPT are not subsidized by the national health system, and only a very limited number of people with diabetes have access to this type of treatment due to its high cost. Insulin pump therapy is around 800 USD per month, plus the initial purchase of the pump, which costs around USD 9000.
What about getting admitted to hospital?
The National Integrated Health System Law (18.211) establishes that all people have the right to health. Therefore, if a person with diabetes should need to be hospitalized for any reason, they must be admitted, both in public and private health centers. The law would also cover the costs of the intervention. Private facilities are usually quicker and better quality than public ones. It should be noticed that private health insurance companies do not accept people with pre-existing conditions, such as type 1 diabetes.
How does diabetes care vary throughout Uruguay?
Diabetes care varies throughout Uruguay, being more precarious in rural areas due to infrastructure. There is a lack of specialized diabetes medical teams and you will find no diabetes awareness or education for the populations there. The doctors who specialize in diabetes are located in Montevideo, the capital of the country. This means if there is any new type 1 diabetic diagnosed in rural areas, they are usually referred to be treated in the capital, especially children with type 1 diabetes.
Francisco Javier González from the Uruguayan Diabetes Association (opens in a new tab) provided this information, with translation help from Alejo de Castillo and Santiago Paulos.
Last updated 2018
