New law may affect chronic patients

Minister of Health Dr Aaron Motsoaledi. Photo: Supplied

Patients with chronic health conditions might have to cough up more money for treatment when the law to allow medical aid schemes to reduce what they pay for prescribed benefits is passed.

However, Profmed chief executive Graham Anderson said the proposed amendments were intended to ensure medical schemes remained sustainable, and a financial benefit accrued to medical scheme members. He said the proposed amendment meant that medical aid schemes will no longer be compelled to cover all the prescribed minimum benefit costs.

Prescribed minimum benefit is what medical aid schemes are compelled to cover in full for certain conditions and illnesses. “Prescribed minimum benefits set out a list of about 300 medical conditions, including emergency, chronic and dread diseases, such as cancer.” Anderson said.

Currently, medical schemes must cover the full cost for these conditions, regardless of the healthcare provider’s fee.

“However, paying in full has proved problematic for medical schemes as the law does not set tariffs,” he said.

This, said Anderson, was making medical aids less sustainable.

“While the proposed amendments are likely to cause anxiety for many medical scheme members, schemes will still, in fact, pay for these conditions, but at reduced rates,” he said.

“We believe the amendments will actually make medical schemes more sustainable and that future annual medical scheme contribution increases should be smaller than in recent years, making medical scheme cover more affordable.”

Sifiso Kaisa, a medical aid scheme member who is on treatment for hypertension said the proposed amendments were ill-advised. “I think the government should be doing all it can to protect us, the ordinary citizen instead of seemingly siding with big business. We are barely making do with the current schemes and having to pay more will just drive us into the public healthcare system,” he said.

Piet Janse van Vuuren, an elderly man and diabetic, said the amendments were a measure to lure medical aid members from private healthcare to the public healthcare system. “With the developments regarding the national health insurance, I am not really surprised at this. The government is trying to make private healthcare inaccessible so that we are forced to resort to the public healthcare system,” he said.

A recent Human Sciences Research Council and the Medical Research Council study warned that South Africa could be heading for disaster due to the high prevalence of people living with chronic diseases. Health Minister Aaron Motsoaledi said the country could be headed for an emerging epidemic if the number of people living with ‘chronic diseases of lifestyle’ did not decrease.


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Andrew Ngozo

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