Traditional healers and medical schemes
There's grave concern about the lack of healthcare workers in South Africa. Yet we have a large base of traditional healers that could play a more prominent role – if certain hurdles can be overcome.
South Africa’s ratio of health workers per 100 000 people is almost 23% lower than the global average.
According to a recent study undertaken by the trade union Solidarity, we currently have a mere 468 health workers for every 100 000 people, compared to the global average of 607 health workers per 100 000 people.
"But when we say we don't have enough doctors, we almost never see a reference to traditional practitioners," says Prof Heather McLeod, consultant on health policy and social security issues to the South African Government and extraordinary professor at Stellenbosch University's Department of Statistics and Actuarial Science.
McLeod spoke at a recent media conference in Cape Town, organised by the Health Products Association of South Africa (HPA).
Currently, an estimated 185 500 traditional medicine practitioners practise in South Africa, compared to some 34 000 doctors of whom a mere 7 000 are GPs in private practice. Yet this fact is seldom acknowledged in reports on the country's dire healthcare situation, which instead focus primarily on the lack of allopathic, or Western, practitioners.
Consumers driving change
The underlying implication, it seems, is that traditional medicine shouldn't be taken seriously.
But an ever-increasing consumer demand for traditional, complementary and alternative medicine (T-CAM)* tells a different story. In 2006, South African consumers spent approximately R3 billion on traditional medicines and R4 billion on complementary and alternative medicines. Clearly, the South African public is readily embracing T-CAM products and services.
South African consumers aren't unique in this respect either. In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care. The use of complementary and alternative medicine (CAM) is also increasing rapidly in the developed world, where 70% to 80% of the population has used some form of CAM.
"This isn't fringe anymore," says McLeod. "This is becoming mainstream."
Pricing of T-CAM therapies problematic
But despite the fact that consumers are driving demand for T-CAM products, services and providers, many medical schemes still fail to cover medicine beyond the sphere of the conventional.
One of the obstacles, McLeod believes, is that medical schemes don't know how to price T-CAM therapies. As a result, medical schemes tend to categorise these therapies into the medical savings account, or the self-funding gap. Ultimately, the scheme member, and not the medical scheme, foots the bill.
For many of the schemes, the alternative medicine marketplace and the different types of services is unfamiliar territory.
McLeod quotes Thomas Snook, principal and consulting actuary at Milliman, Inc in Arizona, who says: "Health plans don't have enough experience with these services to know what constitutes a well-designed benefit, or to accurately estimate the cost associated with such a benefit. Thus, while health plans may be starting to include coverage for these services, they're largely proceeding slowly and cautiously."
According to McLeod, the sequence is that the trustees of a certain medical scheme, after pressure by members, may want to include a T-CAM benefit. The health actuary is then typically involved in designing the benefits and calculating the contributions that will be needed. If the actuary is unfamiliar with T-CAM, they may argue that they can't price the benefits.
Taking up the challenge
There are, however, medical schemes that are making inroads – despite these hurdles.
The Government Employees Medical Scheme (GEMS), for example, covers traditional healers as well as certain CAM modalities, while Bonitas covers the services of CAM practitioners who are registered with the Allied Health Professions Council of South Africa (AHPCSA). The Naspers group's in-house scheme also covers CAM modalities if the practitioners are registered, and if approved tariff codes are used.
"I think that where there is a will, the actuary does find a way," McLeod says. "If the trustees push hard enough, backed up by member demand, the actuary may overcome any reticence."
Lack of regulation, structure
But Victor Crouser, Alexander Forbes' head of healthcare for the coastal region, says it's less about the "will" of medical schemes to cover T-CAM, and more about the lack of regulation and structure.
"As far back as 10 or so years ago, Fedsure Health launched a product aimed at alternative health products, but had to close down the product due to the lack of coding and 'abuse' in claims," he says. "Certainly schemes could price for these products, and many would actively support a move in this direction, but the big question is how to monitor and control claims and services."
He notes that without regulation, schemes would be unable to assess the validity of claims, and would open the scheme to potential unproven treatments and providers.
"The efficacy of many treatments remains largely unproven scientifically," Crouser continues. "It's necessary to ensure that the scheme would only be liable to pay for proven and widely recognised treatments, rather than opening the scheme up to claims from potentially fraudulent and opportunistic operators."
What the future holds
In future, traditional medicine may well be integrated into our national health system. The hope is that this will be done in combination with a sound national policy and the proper regulation of products, practices and providers.
Draft regulations for complementary products were published in 2008, with the overall intention of ensuring that products are effective and safe, and that quality standards are upheld. "This process is ongoing and will eventually result in better regulation and control of these products, thereby ensuring that the general public are protected against unscrupulous operators," Crouser says.
As far as providers and healers go, it will also be necessary to ensure that recognised and widely accepted standards are adhered to.
(Carine Visagie & Sapa, June 2009)
*The term "traditional medicine" (TM) is used to refer to systems such as traditional Chinese medicine, Indian Ayurveda and Arabic Unani Tibb medicine, and to various forms of indigenous medicine in Africa, Latin America, South-East Asia and the Western Pacific. In countries where the dominant healthcare system is based on allopathic medicine, or where TM hasn't been incorporated into the national system, it's termed "complementary and alternative" (CAM).
- World Health Organization, Fact Sheet on Traditional Medicine, December 2008.
- World Health Organization, Traditional Medicine Strategy, 2002 – 2005.