The biomedical universe and individual suffering

Diabetic patients' pathways in the Hungarian Health Care system

Abstract

Among care regimens for chronic diseases, diabetes care is special. While modern diabetes care is primarily centred on medical treatment, the factors that contribute to disease emergence and progression are mostly outside its realm. Medical treatment of diabetes can often have the conflicting goals of lowering blood sugar levels or preventing the often-fatal consequences of the disease. In alignment with the broader patterns of "pharmaceuticalization" within medicine, the focus of diabetes therapies is increasingly shifting toward drug prescriptions, which represents a biologically oriented model of diabetes management.

Major parts of the patients’ pathways, therefore, consist of searching for the appropriate drug. Given the large probability of complications and other related problems, this task can only be carried out by the cooperation of physicians and patients. Finding and adjusting to the proper medication (be it a pill or insulin) needs attentive, caring medical regimes open to the non-medical aspects of disease management.

This study represents the perspective of diabetic patients on their own treatment. We used the narratives provided by 24 interviews: 4 from each of 6 different regions of Hungary. According to the narratives, three different regimens of care could be distinguished: neglective, routine-business-like, and attentive. The best outcome can be expected in attentive regimens. Pathways were examined as moving toward more attentive regimens.

The quality of care was originally not necessarily in line with the economic standing of the area, except for the most deprived area, from which nobody reported experiencing attentive care. Inequalities in the probability of finding a more attentive provider in case of need is a main factor shaping inequalities in care. This probability is influenced by the factors of living in larger settlements, having better transport connections to large centres, having more financial resources, or having a large national (general or specialized) treatment centre nearby. Inequalities are, ironically, moderated by the fact that less well-off patients have more serious comorbid conditions and are treated by other specialists who may be able to correct the shortcomings of the specialised diabetes care.