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Breast cancer - check your medical scheme benefits

Written by Vicki Pinkney-Atkinson.

Breast cancer is the most common cancer in women in rich and poor countries. In 2012, breast cancer was present in 6.3 million women worldwide. According to the World Health Organization, breast cancer is the most common cause of cancer death among women with over 522 000 deaths recorded in 2012. According to the National Cancer Registry, 1 in 27 South African women will be diagnosed with breast cancer in her lifetime.

Men can get breast cancer but it is rarely diagnosed.

Conditions related to breast cancer are prescribed minimum benefit (PMB) conditions.

To read more, please click here.

In memory of Yvonne October 2014

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Call for submissions Market Inquiry - Save the Patients' Fund

Written by Vicki Pinkney-Atkinson.

Equal access for patient groups needed

The Health Market Inquiry into the Private Healthcare Sector is well underway with the publication of processes and an agenda.

However, despite our desire to be involved, patients and patients' groups are having a hard time being heard. It is a little like the "Animal Farm" maxim that eventually said "some animals are more equal than others". Healthcare consumers or patients have had a hard time getting a look in on the proceedings or to participate until now. So far involvement has really been beyond the capacity of most patients / consumer or patient civil society organisations. This is not a wail or, “woe is me” statement but a reality.

Groups with big budgets dominate so far. Groups of suppliers and providers (including medical schemes, pharmaceutical, hospital and doctors groups) with big budgets to hire multiple consultants, advocates and a retinue of helpers. Patients or consumers, who ultimately fund the entire system will be left out in the cold unless we find a source of funding to enable we, the patients, to participate on an equitable basis.

The first step in this campaign for equal access to the Health Market Inquiry is to make a submission. Please complete the comment slip below to let get involved with our campaign.

Deadline 31 October 2014

This is the opportunity for patients / consumers to make a submission are based (but not limited to) the following "statement of issues":

  • Factors driving costs, prices, and expenditure in private healthcare;
  • Market power and distortions of competition at various levels of the sector;
  • Barriers to entry and expansion by firms at various levels of the sector;
  • Factors limiting access by consumers to private healthcare, including affordability;
  • Imperfect information as it affects consumers as well as firms in the sector;
  • The impact of the regulatory framework (including various statutes, regulations and rules) on competition in private healthcare;
  • The specific impact of interventions previously made by the competition authorities in regard to the healthcare sector; and
  • The interaction between the public and private healthcare sectors.
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Big money to influence healthcare - secrets

Written by Navjoyt Ladher, clinical editor, The BMJ .

The hidden interests of lobbyists also come under scrutiny in the British Medical Journal (23 May 2014), with calls for media organisations to be more transparent about the potential conflicts of interest of interviewees.

The perception that lobbyists and think tanks represent an independent point of view is false, argues Meg Carter, and she highlights the BBC’s recent coverage of the debate over plain packaging of tobacco products as an example. A member of the right wing think tank the Institute of Economic Affairs was invited on to BBC Radio 4’s Today news programme to argue the case against brand free packaging. The arguments presented were similar to those of the tobacco company Phillip Morris, one of several big tobacco funders of the institute—links that the BBC failed to clarify during the debate.


Lobbyists are active in many areas of healthcare where businesses have a vested interest. Not only tobacco but salt, sugar, climate change, health service delivery, and alcohol are all areas that are subject to attempts to influence legislation and policy.

In the United States the spend on healthcare lobbying in 2012 was just under $0.5bn. (Vicki's note: the biggest lobbyist by far in US healthcare is that of doctors - the American Association. Makes you think doesnt it?)

It’s a big business, and key players will often be invited to offer comment and opinion in the media. Where there are commercial and competing interests it is vital that media organisations make these clear so that audiences can make an informed judgment on the issues being discussed. As Tamasin Cave, director of Spinwatch, explains in Carter’s feature, "Lobbyists and the interests they represent have a right to be heard. But all of us—including the media—must engage in a more mature discussion of lobbyists’ role. End the secrecy and everyone will benefit."

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When is an emergency an emergency? PMB definitions

Written by Vicki Pinkney-Atkinson.

Is this a first year philosophy question? No, it’s a real problem that I am facing right now.

The answer is that it depends on whether you want your medical scheme to pay for it in full or not.

Fact: All medical emergencies are PMBs which require full payment from you medical scheme.
However, like Orwell’s Animal Farm some emergencies are more equal than other. You might have an emergency and your healthcare professional can diagnose it is an emergency. However, that is not enough. The secret is that there are grades of emergency. Only the most important level of emergency will be paid as a PMB.

The test is that it must be serious, it must be sudden and require immediate medical or surgical treatment.

Here is my example.

Last year I was admitted to hospital with meningitis and spent some time in high care. A few days after return to the general ward I had a major bleed from somewhere in my gastrointestinal tract. I awoke in high care being with a “line” going into my heart and being made ready for an endoscope.
I wanted to delay the endoscope but was told: "Your haemoglobin levels are too low and if we dont do it now your condition will be too critical to give you an anaesthetic.” My haemoglobin was 5 rather than around 12 (units don’t matter here).
You can tell I made it through or I wouldn’t be writing this. Only thing is I needed to another emergency colonoscopy the next day. Looking at it from another point of view. At least I had had a few pints of blood by then but I was still bleeding.

Here is the rub. Six months later the hospital claims department is want a co-payment for the endoscopies.
The question is was this a sufficient and necessary emergency?

You let me know what you think while I wait for adjudication.

You need to check your hospital bills and ask questions.

The Medical Schemes Act 131 of 1998 defines an “emergency medical condition” as “the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part, or would place the person’s life in serious jeopardy”.

More information Drawn from Council for Medical Schemes CMScript 6 2012

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MEDICAL SCHEME INFORMATION TOOL

Written by Vicki.

 

The Medical Schemes Information Tool highly recommended website to give you facts about 24 medical schemes and the 138 related options currently available in South Africa from one source.  The website is funded by Innovative Medicines South Africa (IMSA) and for further information contact 011-880-4644 or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

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