SA's sick healthcare

May 27 2013 07:42
*Mandi Smallhorne
DO YOU love your medical aid like this?

A relative in the UK posted a Facebook friend’s story. Seven years back, this chap, Brian, went to King's College Hospital in south London to have his eyes checked, following peripheral vision problems.

He was expecting to be told he had an infection or something like that. Instead, he learnt that he had a brain tumour and wound up in theatre about a week later having a complicated nine-hour op.

And then another three ops over the course of a year, followed by months of radiotherapy. His tumour, says Brian, was “quite the tenacious little bastard”.

“The radiotherapy ended five years ago and since then I have worked, played, welcomed my daughter into our family and generally just gotten on with things,” he says.

He never once had to worry about cost,; or think that perhaps he might be getting better treatment if he could only afford it; or worry that he was a burden to the National Health System (NHS).

And, he says, he was treated with respect and concern and given all the info he needed throughout.

“I love the NHS and what it stands for. I worry hugely about what is being done to it by the present government. […] Of course there are problems with it. It’s a massive organisation. It’s an integral part of this society.

"So, address the problems, don’t claim that everything can be sorted by turning it into a private enterprise. Investors generally care about one thing- the return on their investment. The idea that a quest for profit is somehow going to enhance the level of care for everyone is absurd.

“This is my NHS story. [...] I want people in years to come to be able to tell the same kind of story.”

I wouldn’t mind shelling out enough to cover the bond on a decent townhouse every month if I could feel the same way about medical aid – but I don’t.

I’ll put up with the small irritations, the shifting goalposts and the impenetrable fog of small print, but when something big comes down the pike, you need a system that works smoothly and doesn’t constantly trip you up – or come across as deeply, deeply concerned about only one thing, and that is profits (aka denying payment).

Someone I love is having treatment for cancer. So thank heavens for medical aid, right, without which he’d be in deep doo-doo – do you have any idea what this chemotherapy stuff costs?

But he had to have an MRI scan. So he asked for pre-authorisation, as per requirements. They would only pay about two-thirds of the cost, the medical aid said, but here’s your authorisation for that.

He went ahead and had the scan, paying the couple of thousand that was not covered out of his own pocket.

Skip ahead a few weeks, and the phone rings. It’s the radiologist’s rooms, saying he owes them another R2 000. It takes about half an hour on the phone to find out why: the medical aid may have authorised the expenditure, but there weren’t enough funds “for scans”, they said, to cover the authorised amount.

Now I ask you, with tears in my eyes: who should have known that at the time of the request for authorisation: the medical aid or the sick man, coping with one of the more difficult periods in his life, huh? Did the medical aid not have access to that info on his profile/file/whatever when they did the authorisation? 

I’m not sure who this system is working for, because every time I open the subject, people have similar tales to tell. (Well, it’s evidently working for the medical aids – the biggest in the country reported a “performance operating profit” that grew by 14% to R1.8bn last year – like medical costs, that pretty comprehensively beats inflation doesn’t it!)

Which is why I’m in favour of the idea – let me stress that, the IDEA – of National Health Insurance (NHI).

And at a recent function attended by loads of healthcare role players and addressed by Minister of Health, the impressive Dr Aaron Motsoaledi, I was quite startled to see how much support it has from organisations that represent healthcare professionals as well as medical schemes.

I know at least one ancillary profession sees NHI as opening up a whole new stratum of potential clients, the previously uninsured who will, with NHI, have coverage.

Of course the elephant in the room is implementation – we’re so good, in this country, at producing plans and green papers and white papers and commissions and development plans and and and… but we fall down over and over again when it comes to implementation.

That it, or something like it, has to happen I have no doubt. The minister predicts the collapse of the private healthcare system (and not just in South Africa).

In its present form, it is simply untenable, a hugely expensive monster that raised R84bn in 2010 to serve a mere 16% of the population (about eight million out of 50 million or so).

I wish for a future where no one needs to fear the costs of illness or injury.

I wish for a future where people I love can come away from a dread-disease experience saying: “I love the NHI,” rather than feeling as though they’ve been worked over twice, once by the disease and the treatment, and once by the medical scheme.

 - Fin24

*Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own.


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