Medical Aids Are Hassling Doctors and Specialists

South African doctors and specialists are battling to just get on with the job of being doctors and saving people’s lives. This is because of ongoing interference from medical schemes. Instead of being able to fight for the lives of their patients, they are being told by the medical schemes 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 only cost-effective supplies are used. 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,  suggested it was a sad day when cardiologists had to be battling with the medical schemes of their patients to get them to pay up for procedures they so desperately needed in order to get better. Another cardiologist, Dr Jean Theron, said that doctors were well aware of affordability issues for patients and avoided procedures that were overly expensive or that would add little value.

Doctors and Specialists and Medical AidsDr Kettles continued to say that it was scandalous that medical schemes wanted to actually control the operations their members were to have, and that they would only pay for certain procedures and medications.

It is ironic that doctors are being asked to go against what they declare, and that is their commitment to assume the responsibilities of the medical profession. Doctors solemnly promise to serve humanity to the best of their ability – caring for the sick, alleviating pain and suffering and promoting good health.

Doctors and Specialists Are Not Supposed to Act That Way!

Doctors also swear to practice medicine with integrity, honesty, and compassion, and to never intentionally do anything to harm their patients and to appose policies in breach of human rights and to not participate in them.

Dr Kettles and other medical professionals are being asked to go against that they have sworn to – to 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.

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