WHAT YOU CAN DO
There are cost-effective options for the treatment of the disease, writes
Last year Health Minister Aaron Motsoaledi said that if no drastic action against unaffordable cancer and tuberculosis drugs was taken, the country would be counting body bags like it was at war. Unfortunately, it doesn’t look like much has changed since he made the contentious statement because just last month the Competition Commission highlighted the exorbitant fees patients must pay in order to fight the battle against cancer.
In June the commission issued a statement saying it would initiate separate investigations against global pharmaceutical companies Roche, Pfizer and Aspen for suspected excessive overpricing of cancer medicines. For example, with Roche, the commission pointed out, a 12-month course of Herceptin in the private sector costs more than R500 000 and more if a higher dose is required. “As a result of exorbitant prices, most breast cancer patients in both the private and public sectors are unable to get treatment,” said the commission.
Herceptin is not the only expensive cancer treatment. According to an editorial by the SA Medical Journal, new-generation immunotherapy drugs such as Ipilimumab cost around R1 million, while immunotherapy for metastatic melanoma will set you back about R1 million.
THE STRUGGLE BY PRIVATE AND PUBLIC INSTITUTIONS
In the private sector, the cost of cancer treatment is impacting on medical scheme premiums, making them unaffordable. “There is an increasing number of new cancer medicines that are extremely high cost, and Discovery Health is concerned by the impact of these high drug prices on the cost of claims, which drives premium increases over time, making it harder for members to afford their medical aid premiums,” says Dr Jonathan Broomberg, CEO of Discovery Health. 1
If you know cancer runs in your family it’s probably best to sign up to a medical scheme. Most medical schemes have now introduced medical cover for low-income earners.
It often means you will use a specific GP or hospital network which the scheme has agreed tariffs with in an effort to keep costs down.
Speak to your broker to get the right cover. “The rule of thumb is contributions should not exceed 10% of your monthly income,” says Gerhard Van Emmenis, principal officer of Bonitas. 2
Hospital plans are generally cheaper and provide basic medical cover for in-hospital procedures and check-ups – including 27 chronic conditions. “Most people usually combine gap cover with a hospital plan. Gap cover is not offered by medical schemes and is a separate health insurance product,” says Bonitas. Gap cover can range from R120 to around R300 per month and can include emergency room visits and additional benefits for oncology (cancer), MRI/CT scans and more.
These increasing costs have resulted in most medical schemes being very conservative with their efforts in treating cancer. They do, after all, have to maintain the pool of funds to ensure that it covers all their beneficiaries.
“As a rule, experimental treatment is not covered by medical schemes. In exceptional circumstances, on a case-by-case basis, we do review selected motivations from treating doctors for specific named patients where there are no other treatment options available,” explains Broomberg.
Meanwhile the public healthcare sector is also 3
Consider other products too. “For under R200 per month you can get a dread disease cover that ensures you have financial peace of mind when the unthinkable happens. The All Woman policy includes a lump sum payout if you are diagnosed with cancer and even covers up to four children on the policy for certain cancers,” points out Robyn Farrell, trustee of 1st For Women Foundation. 4
If you can’t afford private medical care, you’ll have to go to a state hospital. You’ll be charged according to your employment status.
squeezed by the cost of treating cancer. According to the SA Medical Journal editorial, this squeeze could preclude the sector from providing even the most cost effective treatment programmes. In addition, patients also suffer long treatment delays as there’s a shortage of oncologists as well as limited resources.
So, regardless of whether you can afford private medical care or rely on the state healthcare system, you may not get the latest treatment available. “In all health systems, whether public or private, funds are limited and therefore it is impossible to provide 5
You could also get treatment through hospices, for free if you can’t afford the care. At HospiceWits home-care visits cost R750 a time, while inpatient visits cost R2 450 per day. “We will always issue a bill to show what people owe but if they say they can’t afford to pay then we don’t ask them to. We often find family members are touched by the quality of care and will make donations as they can. We take their word if they say they can’t pay,” says Joy Ruwodo, marketing manager at HospiceWits.
benefits for every treatment to everyone,” adds Heidi Kruger, an independent medical scheme expert.
This doesn’t mean you’ll be given no treatment for cancer. For state patients it means you’d be getting conventional treatment, such as chemotherapy. When it comes to medical aids they are obligated to treat you in most cases.
“According to the Medical Schemes Act, medical schemes must cover treatable cancers. These are listed in the prescribed minimum benefits,” points out Kruger.