Unhealthy assistance

2008-04-08 00:00

THE concept of a medical scheme to assist its members in meeting expenses is in principle a good one, a form of making provision in the good times for any bad times ahead.

In recent years, however, as medical expenses have escalated sharply, especially in the private hospitals which are run as money-making enterprises for the benefit of shareholders, medical aids have become increasingly authoritarian and bureaucratic.

Medical aid members will be aware that over the years they have been called upon to pay more and more for less and less. Anybody who has had the misfortune to be hospitalised will know that the bureaucratic hurdles to be surmounted in terms of getting prior authorisation from a medical aid often make the subsequent medical proceedings a comparatively minor event. And having to do battle with medical aids is becoming an increasingly important aspect in the work of any doctor.

The Council for Medical Schemes has recently had the temerity to challenge the right of an insurance company to sell policies which cover the difference between what specialists charge and what medical aids are prepared to pay in terms of their tariff of fees. These gap-cover products have already been purchased by 54 000 families, who will doubtless be relieved to learn that the Supreme Court of Appeal has overturned a High Court interdict prohibiting the company concerned from selling its policies.

The latest medical aid bombshell is the collective decision to stop paying for elective Caesarean sections as from April 2009 on the grounds that these are more expensive than natural births.

While there are medical arguments both for and against Caesars, the decision is yet another unfortunate instance of the freedom of choice of patients being restricted for financial considerations.

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