Court judgement silent on the plight of SAMWUMED members

The North Gauteng High Court has denied SAMWUMED and the Board of Health Care Funders (BHF) leave to appeal a court case against the Council for Medical Schemes (CMS) and 12 other private sector organisations including the Hospital Association and Private

The November 2011 judgement, upon which this leave to appeal was based on, did not deal with the merits of the case and instead upheld the technical points raised by the respondents and ruled that BHF lacked the necessary locus standi to have brought the matter of Regulation 8 to court. However, the court is silent on SAMWUMED’s status as a co-applicant appealing on behalf of its members. Many of whom are low-income earners from the local government sector and related services.

Regulation 8 of the Medical Schemes Act deals with the diagnosis, treatment and care costs related to Prescribed Minimum Benefits (PMBs) of 270 regulated conditions by ensuring that even when medical aid benefits are exhausted the medical aids may not refuse to pay for treatment of these conditions.

Currently, many private healthcare providers – private hospitals, specialists(including radiologists and pathologists) blank cheque into medical aid funds and are forcing medical schemes to pay whatever they charge. This kind of open-ended liability threatens medical aid risk pools, these are funds which come directly from members’ pockets (through their medical aid subscriptions). In the absence of a fully-functional healthcare system, many workers have no choice but to resort to the private sector for much-needed care. Allowing private providers to charge what they like only serves to fatten their already fat coffers. From a patient perspective we cannot reasonably see how the Registrar can claim this judgement is a victory for medical aid members in the face of astronomically rising health costs.

SAMWUMED and BHF, on behalf of medical aids, are seeking to find a fair and regulated cost structure rather than allowing medical aids to be plundered.

The Minister of Health, Comrade Aaron Motsoaledi, has expressed his dismay at the current situation and has indicated intention to establish an independent commission to look at aspects of pricing with the ultimate aim of regulating healthcare prices. Obviously, he will be opposed at every turn by service providers who benefit so enormously from the current environment at the expense of the working class.

The South African constitution lists the right to health care together with food, water and security. Access to these needs is a right that every South African should have undeniable access to. The constitution further states that government must take legislative measures to achieve the progressive realisation of these needs.