Medical aid schemes owed R215.3-million to the provincial department. Data from the end of last year show that by far the biggest chunk of the debt (R1178943000) is owed by the Road Accident Fund. Several government entities including the national departments of correctional services, defence and justice were listed among those owing the provincial department a staggering R2.7-billion.
The Gauteng health department is drowning in debt owed largely by medical aid schemes, self-paying patients and other provinces. Naomi Levitt, director of CDIA, said a lot of money has been invested in tuberculosis and HIV research, leaving little room for other diseases that have an impact on Africans such as hypertension and diabetes. “When we find out about fraud we terminate the patient’s membership, report the doctor to the Health Professions Council of South Africa and get our money back,” Broomberg said.ĭuring the summit it was announced that the Chronic Disease Initiative in Africa (CDIA) would receive funding for a year from Discovery for the work they do. He would not be drawn into revealing which hospitals were the worst culprits but said that hospitals in KwaZulu-Natal were among the worst. “It is a collaboration between doctors and patients in the hospitals,” Broomberg said. Hospital cash plan members also stay in hospital between 40% and 60% longer than Discovery Health Medical Scheme members, according to claims submitted. Broomberg said the average patient admissions on hospital cash plans are five times higher than those on the Discovery Health Medical Scheme. “There are concerns over the significant differences in hospital claims for medical schemes and hospital cash plans,” he said.
He said the types of fraud that most commonly occur are false claims, receiving non-healthcare merchandise but claiming for healthcare services, and cosmetic surgery submitted as approved medical procedures. This is crippling the healthcare system, a medical aid scheme head has said.ĭiscovery Health chief executive Doctor Jonathan Broomberg said this yesterday during the Discovery Health 2020 Media Summit. Doctors and patients conspire to commit fraud, particularly with hospital claims. Healthcare fraud is costing South Africa between R8.22-billion and R43.2-billion annually. The South African Depression and Anxiety Group (Sadag) also made submissions on the inadequate PMB cover for mental illnesses and limited treatment cover for non-PMB cases.Ĭassey Chambers from Sadag said the private health system was not patient-centred, PMB conditions needed to urgently be reviewed and mental health needed to be taken seriously Regarding the escalating cost of private healthcare, Mark Heywood from Section27 suggested that medical aids should have the duty to provide more information not only about the cost of treatment but also about the benefits available to patients. Rugege noted that the threat of litigation and the involvement of lawyers seemed to be required for access to healthcare for PMB cases. Their provisions are to protect the rights of users," she continued.
#Medihelp necesse 2016 full
"PMB provisions require schemes to pay in full without co-payments or deductions for diagnosis, treatment or care. Section27`s Umunyana Rugege said failure to comply with PMBs exposed people to a reality of aggravated illness, placing users of medical aids under significant physical, emotional and financial strain. He added that medical aids were using PMBs to decide which diseases to cover, stating that chronic diseases should not be treated as such. The PMBs are zama zamas - a house that is cracking," the minister said. "Private healthcare is exorbitantly priced, and PMBs are a symptom of a system that needs massive reorganisation. However, Section27 revealed that there were a number of complaints at the Council of Medical Schemes concerning the non-payment of PMBs. He was commenting after submissions made by the NGO Section27 as well as the personal accounts of medical aid members yesterday and on Tuesday There are 270 diseases, of which 27 are chronic diseases, that medical aids are meant to cover in full. PMBs are a set of defined benefits which ensure all medical scheme members have access to certain minimum health services, regardless of their benefit choice.Īt the Competition Commission`s Health Market Inquiry held in Pretoria yesterday, Motsoaledi likened medical aids` use of PMBs to illegal miners digging for gold. Health Minister Aaron Motsoaledi has lambasted private medical aid schemes for "exploiting" prescribed minimum benefits (PMBs) and making them their "zama zamas".
0 kommentar(er)
