WHAT YOU CAN DO

There are cost-ef­fec­tive op­tions for the treat­ment of the dis­ease, writes

CityPress - - Business -

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.

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