At a recent press conference, the SA Depression and Anxiety Group (SADASG) highlighted the suffering of mentally ill patients seemingly being discriminated against by medical aid schemes failing to provide reasonable cover for the treatment of mental illnesses.
The questions asked by conference participants were whether such discrimination did not contravene patients' rights under the Constitution and the government's 1999 Health Charter and why, in fact, mental illness should be treated as separate from other illnesses, since many of these conditions have physiological or genetic origins.
Medical aid scheme members who believe they have been short-changed by their medical schemes spoke despairingly of having to deal not only with their debilitating illness, but immense financial hardship in the face of massive medical aid contribution increases, with drastically cut benefits. In most schemes, fund allocation for treatment of mental illness is woefully inadequate, forcing needy patients to forego psychiatric help and to limit, or even stop, the medication that keeps their condition under control.
The mentally ill are being increasingly marginalized by medical schemes aiming more at saving costs than the best interests of their clients, the patients. Amounts allocated for mental health treatment rarely exceed R1 000 per person per annum. This would barely cover more than two to three professional consultations.
Drug treatment options are also under threat. Anti-depressants offer the majority of depression and anxiety sufferers a new lease of life, yet more than ever, medical schemes are refusing to authorize the most effective new generation drugs, arbitrarily replacing them with generics. Although these may help some patients, many find them less effective and relapse is not uncommon. Because suicide is one of the more serious complications of untreated depression, effective drug treatment simply cannot be ignored.
It is not only the patients who are angry and frustrated. Psychiatrists take a dim view of medical scheme interference in their area of expertise. Dr Eugene Allers, President Elect of the SA Society of Psychiatrists (SASOP) points out that decisions on medication are made by administrative personnel, not qualified doctors. By overruling doctors' decisions on what is right for their patients, medical schemes undermine the medical and pharmaceutical professions as a whole.
In view of the fact that a number scheme-authorized drugs tend to be less effective than patented ones preferred by psychiatrists, the apparent cost saving is lost by the need to increase dosages or combine with other drugs for greater effect. SADASG General Manager Lynda Woods considers this to be a false economy. She believes that medical schemes would benefit far more by considering "cost-effectiveness against just cost-efficiency."
Following on from the July conference, SADASG, together with the SA Society of Psychiatrists (SASOP) and other interested groups, have been invited to meet with the Registrar of Medical Schemes, Mr Patrick Masobe and the Council of Medical Schemes, in order to voice their concerns and challenge medical scheme practices from a human and constitutional rights perspective.
