Are some South African medical aids contravening the Constitution?
Barbara Erasmus
Patients suffering from a psychiatric illness may become so disabled that hospitalisation becomes essential but they won’t be treated in the same way as heart patients. If their condition has led them to attempt suicide, some hospitals won’t treat them as some medical aids don’t cover hospitalisation after a suicide attempt.
If they’re in respiratory distress,they may have to pay deposits, which can be as high as R10 000, to cover treatment in an intensive care unit. Other psychiatric patients are penalised for not getting prior authorisation, despite the fact that a psychiatric episode is as unpredictable as a heart attack.
Psychiatrists must submit a lengthy motivation for anti-depressants, which don’t appear on the medical aid’s list of approved drugs. Limits imposed on psychiatric medicine may mean that the patients are forced to stop the medication early, which can lead to a relapse in their condition. Pharmacists sometimes switch to cheaper generics without consulting the doctor who prescribed the medication these can be marginally different with serious side-effects.
Dr Eugene Allers, vice-president of the South African Society of Psychiatrists, says there is huge discrimination by South African medical aids towards mental illness, which is not seen in the same light as other medical conditions.
Polmed, the medical aid serving the police force, classifies psychiatry merely as an “auxiliary service” despite the fact that the violence of South African life exposes this particular profession to situations likely to cause posttraumatic stress disorder. The Depression and Anxiety Support Group, Africa’s largest patient-advocacy group, recently conducted a mini-survey of medical aids. Of the 10 who responded, all provided a scale of benefits for psychological and psychiatric patients that was far lower than for other medical conditions. In some schemes up toR300 000 is available for hospitalisation for other illnesses compared to R6000 for a mental health problem.
Because of the stigma of mental illness, both state-funded health schemes and medical aids deny patients the same rights as people with more general medical conditions. This appears to contravene Section 9 of the Constitution, which states that no person may unfairly discriminate against another, either directly or indirectly. Section 27 guarantees everyone’s right of access to health care and says that no one may be denied emergency medical care. The essential-drugs list is outdated and does not include the new atypical anti-psychotics that the World Psychiatric Association recently identified as the first-line treatment for schizophrenics.
October 10 has been declared World Mental Health Day and this year’s theme is Mental Health and Work, with the focus on raising public awareness of economic issues like absenteeism and productivity.
Both psychiatrists and psychologists have been vocal about the unfair treatment their patients receive, but their influence tends to be disregarded as they are seen to have a vested financial interest in the issue. The patients themselves must become more assertive if progress is to be made and campaigns are under way to increase public awareness.
Statistics available from the South African Depression and Anxiety Support Group, Tel: (011) 783 1474