Medical Aids Are Hassling Doctors and Specialists

South African doctors and specialists can’t get on with being doctors and saving people’s lives. This is because of ongoing interference from medical schemes. That is because the medical schemes are telling them exactly which procedures to offer their patients. Sometimes these operations and treatments are risky and could even jeopardise their lives.

Health care systems are trying to contain costs by ensuring that professionals use only cost-effective supplies. This is a world wide issue and not unique to South Africa. Groups representing medical experts have all criticised medical aids as being a forceful player in price negotiations.

Dr David Kettles, a Port Elizabeth cardiologist,  says cardiologists have to battle against the medical schemes. And that is to get them to pay up for procedures patients need in order to get better. Another cardiologist, Dr Jean Theron, says doctors are well aware of affordability issues for patients. He says they avoid procedures that are overly expensive or that would add little value.

Doctors and Specialists and Medical AidsDr Kettles says it is scandalous that medical schemes wanted to actually control the operations their members were to have. They will also only pay for certain procedures and medications.

It is ironic that medical aids are forcing doctors to go against what they decide. That is because they commit to assume the responsibilities of the medical profession. Doctors solemnly promise to serve humanity to the best of their ability. The promise to care for the sick, alleviating pain and suffering and promoting good health.

Doctors and Specialists Should Not Have to Act That Way!

Doctors also swear to practice medicine with integrity, honesty, and compassion. They must never intentionally do anything to harm their patients. Significantly, they must oppose policies in breach of human rights and never participate in them.

Dr Kettles and other medical professionals have to go against that they have sworn to. Instead they must offer treatments which aren’t the best. He went on to say that his integrity as a practitioner is threatened, calling the actions of the medical schemes as ‘coercive in the extreme’.

It is questionable when you get procedures actually being delayed because the medical schemes want doctors and specialists to motivate why their patients need a specific operation or medication. Dr Kettles said that because of this constant back and forth questioning and debating, patients had to play a waiting game which often resulted in harm to their health and in some instances, to their death.

Dr Kettles felt that as a doctor living up to declarations of integrity, it was his duty and responsibility to inform his patients of their rights.

Commission panel member, a certain Nthutuko Bhengu, told Dr Kettles that while he offered a good case on how medical aids meddle with the doctor-patient relationship, it was the schemes who had to pay for treatment.

Legally, medical schemes are not for profit, but the truth is they are out to make as much profit as they can, to the patient’s loss. Medical aids are run by some pretty strong companies and there are huge profits involved.

It isn’t surprising that many medical schemes are often¬† looked upon as the 3rd party acting as the judge, deciding on the fate of patients, and not being too concerned when that fate includes the patient landing up in a coffin.


All info was correct at time of publishing