Medical aid waiting periods and late-joiner penalties: What. How. Why?

The world of medical schemes in South Africa is a very different one to 25 years ago. There are strict rules and regulations governing the industry, there to protect both the members and the financial sustainability of the scheme. Now is the time of year when medical schemes announce their annual increases and benefit changes.

It means people re-evaluate their existing medical cover and opt for new schemes, new plans or join a medical aid for the first time. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, discusses some of the important membership rules and regulations.

What are waiting periods?
According to the Medical Schemes Act, medical aid schemes are entitled to impose a three month general waiting period. This protects other members of the Fund by ensuring that individuals aren’t able to make large claims shortly after joining and then cancelling their membership.

Unlike other financial products, medical schemes are not-for-profit entities that are regulated to ensure they fulfil a social solidarity role, ie everyone benefits from the dependence individuals have on each other.

There are two types of waiting periods:
General waiting period (up to three months). A beneficiary is not entitled to any benefits, in some instances not even Prescribed Minimum Benefits (PMBs) during this period. If a beneficiary submits claims during a general waiting period, they will not be paid.

Condition-specific waiting period (up to 12 months). A condition-specific waiting period can last up to 12 months. During this time a beneficiary is not entitled to any benefits for a particular condition for which medical advice, diagnosis, care or treatment was recommended or received.

When do waiting periods apply?
Waiting periods generally apply if: You or your dependants were not on a medical aid for a period of at least 90 days before you joined Bonitas; you have never been a member of a medical aid or you chose to move from another medical aid to Bonitas.

When are they waivered?
To children born during membership, as long as they are registered within 30 days of birth.

If application is made to register a foster or adopted child dependant within three months of the date on which fostership or adoption was granted
If application is made to register a spouse within three months of marriage
To a main member who has to join Bonitas due to a change in employment
If your employer moves to another medical aid and the change is made within a 90-day period.

Active members on a medical scheme who have a break in membership of less than 90 days and a previous membership of less than 24 months
Do you pay premiums during this period?
You continue to pay your full premium during the waiting period.

Are PMBs covered during the waiting period?
A PMB is a common, life-threatening chronic condition for which cost-effective treatment would sustain and improve the quality of the member’s life. There are 27 PMB conditions and by law, the medical scheme has to cover the diagnosis, treatment and management of these. This can be confusing when waiting periods are imposed.

Van Emmenis explains, ‘Pre-existing conditions are not simple. There are a series of questions which are asked and factors taken into account when determining when to implement waiting periods. Underwriting is very much based on individual needs. If a potential member is concerned they can request pre-underwriting from Bonitas and engage on a one-on-one basis.’

What is a late-joiner penalty?
In South Africa, medical aid schemes can impose late-joiner penalties on individuals who join a medical aid scheme after the age of 35; those who have never been medical aid members, or those who have not belonged to a medical aid scheme for a specified period of time since April 2001. The reasoning for this is to ensure fairness (whereby members who have been part of a scheme for years are not subsidising newer members who have contributed to the scheme). In addition, it also ensures that medical schemes cannot deny members who wish to join.

These late-joiner penalties depend on age as well as the number of years the applicant was a member of a medical scheme or the number of years they had no cover at all. If you are over 35 and haven’t been on a medical aid then – depending on your age – you will be penalised and charged a surcharge between a 25% and up to 75% loading of your premium. It is outlined by CMS but at the discretion of the Scheme.

Does the loading reduce over time?
No unfortunately not, once you are paying a loaded premium, it remains in place.

Upgrading from a hospital plan
If someone has been on a hospital plan but decides to move to a medical aid and is over the age of 35, a loading will still apply.

Age and infirmity
Late-joiner penalties have been put in place to compensate for potentially increased claims by people who join a medical aid scheme when they’re already older or infirm and can range from 25% of contributions to 75%. These penalties are imposed at the discretion of the medical scheme and apply to all types of medical aid plans, including hospital plans.

Can you move directly from a hospital insurance to medical aid?
Even though hospital plans are now governed by the Medical Schemes Act and not as previously by the Financial Services Board, late-joiner penalties will now apply if you move from a hospital insurance to any form of medical aid (including a hospital plan).

Can a medical aim scheme ever refuse membership to the scheme?
Before 1998 medical aid schemes could refuse membership but this is no longer allowed, although they can now impose waiting periods and late-joiner penalties.

And for immigrants to South Africa?
If you belonged to a private medical aid abroad, the CMS and the scheme will evaluate each individual case, taking into account all the relevant circumstances and any pre-existing conditions.

Can you change your membership any time during the year, is there a penalty for doing this and/or a waiting period?
Yes you can change at any time (but usually this happens during open period with new contracts coming into place from the beginning of a new year). Waiting periods are not usually imposed unless for pre-existing conditions however, the savings allocated to a plan may be. Savings are allocated in advance for 12 months so, if you leave during the year and have used more than the appropriate portion of savings, you will have to pay this back.

What if you change from one Scheme to another?
A three-month waiting period will more than likely apply as well as limited PMB cover and a late-joiner penalties.

Expulsion from medical aid schemes
Van Emmenis says you can only be expelled from your medical aid scheme if you are found to have attempted to or defrauded the scheme. ‘You cannot be expelled on the basis that you have a high claim ratio, the Scheme cannot increase your premiums even if you are costing them a lot of money,’ he says. ‘However, non-disclosure or misrepresentation could result in your membership being cancelled and you being excluded from the scheme indefinitely.’

Van Emmenis says, ‘We encourage members to submit all their bills even if they might not be paid as it allows for a full record of medical expenses and you can assess your medical aid needs going forward.’

In conclusion, Van Emmenis says that he’d encourage people to compare policies across schemes before making a final decision about their medical aid future. ‘Our health is important and it makes sense to do some homework to see what is being offered, whether the plan provides the benefits you and your family needs, what will be paid from risk and the savings allocation and then weigh this up against the monthly premium.’


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What’s driving up our healthcare costs?

Discovery Health CEO explains why South Africans are paying higher medical aid premiums than ever before.

Access to quality healthcare at an affordable price is a critical priority for every family, and in society at large. South Africans lucky enough to afford private healthcare have rapid and convenient access to some of the best quality of care available anywhere in the world, provided by outstanding health professionals in the context of a robust, world-leading healthcare system. But the reality is that public and private healthcare systems around the world are grappling with rapidly rising healthcare costs, and South Africa is no exception.

Discovery Health data indicates that, since 2008, total claims costs have increased by 11.4% per year – roughly 5% above the consumer price index (CPI) each year. Medical aids – non-profit funds by law – thus have little choice but to increase their premiums by about CPI plus 3%–4% each year to ensure they can sustainably pay claims.

Our data shows the prices charged by doctors and hospitals are not a significant cause of this pattern of high claims inflation. Over the past eight years, tariffs paid to doctors and hospitals have increased by 0.5% above CPI each year. The most important cause of high claims inflation is, in fact, the rapidly increasing use of healthcare services by medical scheme members.

What drives these dynamics? The major cause is a combination of ageing and increased levels of chronic disease in the medical-aid membership base. Slow economic growth means fewer young people enter the workforce and join a medical scheme. Schemes are therefore ageing, and with each year of ageing, claims increase by 2%–3%. Simultaneously, medical aids face the global pandemic of chronic diseases of lifestyle. Currently, more than one in five members of the Discovery Health Medical Scheme are registered for one or more chronic conditions, a 61% increase since 2008. Each of these members claims about four times more than a healthy member.

Another contributing factor is that young and healthy people stay out of medical aids until they or a family member need healthcare. Together, these trends mean the average medical-scheme member is older and sicker each year, contributing to the trend of high claims inflation.

On the “supply side” of the healthcare system, a major driver of costs is the rapid emergence of new medicines and medical technologies. Unlike information technology, new technology in healthcare typically comes at a much higher cost. In 2016, the Discovery Health Medical Scheme paid out R1.5-billion for high-cost medicines, up from R400-million in 2008. In 2016, 89 members requiring very high-cost medicines claimed an average of R1.4-million each, and the number of members requiring these high-cost medications has increased seven-fold since 2008.

A final contributor to these cost pressures is the impact of redundant, inappropriate or unnecessary tests and procedures. Conservative estimates put this “waste” at up to 21% of total US healthcare spend in 2010. Assuming that waste accounts for only 10% of spend in South Africa, we estimate that up to R33-billion is being spent on tests and procedures with minimal clinical benefit. Finally, there is the growing challenge of fraud. During 2016, Discovery Health recovered more than R400-million in fraudulent claims on behalf of our client medical schemes and their members, an indication of the extent of the problem.

The bottom line is that rising healthcare costs are a global problem and South Africa is no exception. Discovery Health is deeply committed to tackling these issues actively and robustly. We are hard at work implementing what we call a shared-value healthcare model and are making significant progress, details of which I will be sharing in this column in the coming weeks.

By: Business Live


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Cancer treatment waiting times in KZN increase by almost 30% as services stall

Cancer patients are waiting up to nine months for treatment, says the South African Human Rights Commission.

KwaZulu-Natal cancer patients are now waiting nine months for treatment, alleges Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka.

In a statement, Keeka said South African Human Rights Commission (SAHRC) chairperson Bongani Majola revealed this new information during a recent provincial health portfolio committee meeting. Previously, the average waiting time for treatment was seven months.

The news comes almost four months after the SAHRC released a scathing report detailing the collapse of cancer services in the province. The document accused the KwaZulu-Natal health department and its MEC, Sibongiseni Dhlomo, of failing patients.

After more than a year of investigation, SAHRC revealed that the province lost one oncologist each month over a five-month period. From October to December 2016, a breakdown in cancer treatment machines forced Durban’s Addington Hospital to refer its patients to the nearby Inkosi Albert Luthuli Central Hospital for treatment.

Durban lost its last public sector specialist in June, leaving only two such professionals in the province at Grey’s Hospital in Pietermaritzburg.

As of August, health minister Aaron Motsoaledi had launched a two-week plan to resuscitate cancer services, taking over some of the province’s procurement and human resources functions, said former national health department spokesperson Joe Maila at the time.


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Medical aid waiting periods and late-joiner penalties: What. How. Why?

The world of medical schemes in South Africa is a very different one to 25 years ago. There are strict rules and regulations governing the industry, there to protect both the members and the financial sustainability of the scheme. Now is the time of year when medical schemes announce their annual increases and benefit changes. It means people re-evaluate their existing medical cover and opt for new schemes, new plans or join a medical aid for the first time. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, discusses some of the important membership rules and regulations.

What are waiting periods?
According to the Medical Schemes Act, medical aid schemes are entitled to impose a three month general waiting period. This protects other members of the Fund by ensuring that individuals aren’t able to make large claims shortly after joining and then cancelling their membership.

Unlike other financial products, medical schemes are not-for-profit entities that are regulated to ensure they fulfil a social solidarity role, ie everyone benefits from the dependence individuals have on each other.

There are two types of waiting periods:
General waiting period (up to three months). A beneficiary is not entitled to any benefits, in some instances not even Prescribed Minimum Benefits (PMBs) during this period. If a beneficiary submits claims during a general waiting period, they will not be paid.

Condition-specific waiting period (up to 12 months). A condition-specific waiting period can last up to 12 months. During this time a beneficiary is not entitled to any benefits for a particular condition for which medical advice, diagnosis, care or treatment was recommended or received.

When do waiting periods apply?
Waiting periods generally apply if: You or your dependants were not on a medical aid for a period of at least 90 days before you joined Bonitas; you have never been a member of a medical aid or you chose to move from another medical aid to Bonitas.

When are they waivered?
To children born during membership, as long as they are registered within 30 days of birth
If application is made to register a foster or adopted child dependant within three months of the date on which fostership or adoption was granted
If application is made to register a spouse within three months of marriage
To a main member who has to join Bonitas due to a change in employment
If your employer moves to another medical aid and the change is made within a 90-day period
Active members on a medical scheme who have a break in membership of less than 90 days and a previous membership of less than 24 months
Do you pay premiums during this period?
You continue to pay your full premium during the waiting period.

Are PMBs covered during the waiting period?
A PMB is a common, life-threatening chronic condition for which cost-effective treatment would sustain and improve the quality of the member’s life. There are 27 PMB conditions and by law, the medical scheme has to cover the diagnosis, treatment and management of these. This can be confusing when waiting periods are imposed.

Van Emmenis explains, ‘Pre-existing conditions are not simple. There are a series of questions which are asked and factors taken into account when determining when to implement waiting periods. Underwriting is very much based on individual needs. If a potential member is concerned they can request pre-underwriting from Bonitas and engage on a one-on-one basis.’

What is a late-joiner penalty?
In South Africa, medical aid schemes can impose late-joiner penalties on individuals who join a medical aid scheme after the age of 35; those who have never been medical aid members, or those who have not belonged to a medical aid scheme for a specified period of time since April 2001. The reasoning for this is to ensure fairness (whereby members who have been part of a scheme for years are not subsidising newer members who have contributed to the scheme). In addition, it also ensures that medical schemes cannot deny members who wish to join.

These late-joiner penalties depend on age as well as the number of years the applicant was a member of a medical scheme or the number of years they had no cover at all. If you are over 35 and haven’t been on a medical aid then – depending on your age – you will be penalised and charged a surcharge between a 25% and up to 75% loading of your premium. It is outlined by CMS but at the discretion of the Scheme.

Does the loading reduce over time?
No unfortunately not, once you are paying a loaded premium, it remains in place.

Upgrading from a hospital plan
If someone has been on a hospital plan but decides to move to a medical aid and is over the age of 35, a loading will still apply.

Age and infirmity
Late-joiner penalties have been put in place to compensate for potentially increased claims by people who join a medical aid scheme when they’re already older or infirm and can range from 25% of contributions to 75%. These penalties are imposed at the discretion of the medical scheme and apply to all types of medical aid plans, including hospital plans.

Can you move directly from a hospital insurance to medical aid?
Even though hospital plans are now governed by the Medical Schemes Act and not as previously by the Financial Services Board, late-joiner penalties will now apply if you move from a hospital insurance to any form of medical aid (including a hospital plan).

Can a medical aim scheme ever refuse membership to the scheme?
Before 1998 medical aid schemes could refuse membership but this is no longer allowed, although they can now impose waiting periods and late-joiner penalties.

And for immigrants to South Africa?
If you belonged to a private medical aid abroad, the CMS and the scheme will evaluate each individual case, taking into account all the relevant circumstances and any pre-existing conditions.

Can you change your membership any time during the year, is there a penalty for doing this and/or a waiting period?
Yes you can change at any time (but usually this happens during open period with new contracts coming into place from the beginning of a new year). Waiting periods are not usually imposed unless for pre-existing conditions however, the savings allocated to a plan may be. Savings are allocated in advance for 12 months so, if you leave during the year and have used more than the appropriate portion of savings, you will have to pay this back.

What if you change from one Scheme to another?
A three-month waiting period will more than likely apply as well as limited PMB cover and a late-joiner penalties.

Expulsion from medical aid schemes
Van Emmenis says you can only be expelled from your medical aid scheme if you are found to have attempted to or defrauded the scheme. ‘You cannot be expelled on the basis that you have a high claim ratio, the Scheme cannot increase your premiums even if you are costing them a lot of money,’ he says. ‘However, non-disclosure or misrepresentation could result in your membership being cancelled and you being excluded from the scheme indefinitely.’

Van Emmenis says, ‘We encourage members to submit all their bills even if they might not be paid as it allows for a full record of medical expenses and you can assess your medical aid needs going forward.’

In conclusion, Van Emmenis says that he’d encourage people to compare policies across schemes before making a final decision about their medical aid future. ‘Our health is important and it makes sense to do some homework to see what is being offered, whether the plan provides the benefits you and your family needs, what will be paid from risk and the savings allocation and then weigh this up against the monthly premium.’


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Life Esidimeni: How good people come to do very bad things

Arbitration reveals the skeletons in the Gauteng health department’s closet culture that gave rise to 141 deaths and continues to thrive.

Levy Mosenogi could be described like many men who throughout history who have ended up on its bad side: a religious man and active in his community by his own account during his recent testimony at a Life Esidimeni arbitration hearing.

And when he was tasked with leading the relocation of almost 2 000 mental health patients out of state-sponsored private care at Life Esidimeni facilities, he became even more like those cautionary tales of characters from our history lessons. Not the obvious ones that present themselves in the immediate aftermath of a grave injustice, when narratives are preoccupied with dichotomies of good and evil or victor and villain, but the ones that creep in their wakes in which we begin to understand the importance of what seemed innocuous cameos.

Mosenogi became a man with a mundane title, some power and a sense of what he would later describe as a foreboding.

At least 141 people died as a result of the relocations, arbitration hearings have revealed.

Billy didn’t survive it.

A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

More than two years after the project was announced and a year after the initial deaths emerged, Mosenogi testified late last week at the ongoing arbitration. The process, which takes place in parallel with criminal investigations, is aimed at keeping families and the Gauteng health department out of court.

He described his initial misgivings about the project and how he voiced these to former health MEC Qedani Mahlangu.

“I had a foreboding. When things were discussed, I found the head of department [Barney Selebano] also had serious misgivings.”

Asked what else he did about these feelings of dread, he responded: “I did raise it in my prayer meetings and asked people to pray. I raised it in my organisation [the ANC] in my branch.”

Cullinan Care and Rehabilitation Centre social worker Daphne Ndhlovu was more explicit about why she did not speak out as the centre’s patients began dying after it was allegedly pressured by the Gauteng health department to accept Life Esidimeni patients: she was threatened with being accused of insubordination.

Ndhlovu explained she was essentially following orders: “We knew we were not giving justice to our patients, but it was instructions from above.”
Last week, Mosenogi became one of the first Gauteng health employees to apologise publicly to Life Esidimeni families.

“I apologise for myself. I apologise on behalf of the department of health. The lesson we learnt is to speak truth to power.”

In 1945 and in the wake of World War II, the phrase “I was just following orders” became synonymous with the Nuremberg Trials – the military tribunals designed to bring Nazi leaders to justice. So famous is the association that, today, the “an order is an order” plea is often referred to as the “Nuremberg Defence”. Although the defence did not absolve those prosecuted at Nuremberg, it has worked intermittently throughout history since the Roman Empire.

Only two Gauteng health officials – Selebano and director of the mental health directorate Makgabo Manamela – have been suspended and are facing disciplinary action, says Gauteng deputy director general of communication services Thabo Masebe.

The pair have garnered a collective R1.3-million in wages while on suspension, alleges the Democratic Alliance’s Gauteng shadow health MEC Jack Bloom.

The former Gauteng health MEC says it wasn’t her job to visit organisations prior to transferring state patients into their care.

In 1963, Yale University psychologist Stanley Milgram released the first results of a series of studies – in part inspired by the Nuremberg proceedings – designed to reveal why seemingly good people could be ordered to do bad things.

In his research, published in the Journal of Abnormal and Social Psychology, Milgram tested how many people could be successfully ordered to administer increasingly painful shocks to a fellow participant.

Although this fellow participant was an actor and the shocks were fake, Milgram found that almost two out of every three people among a group of 40 were willing to deliver the highest shock possible, 450 volts, when told to do so.

Although Milgram’s work fell prey to a bevy of allegations, including data tampering, the quest to understand “the banality of evil” continues to fascinate psychology. Until recently, much of this work focused on the kind of factors, for instance, environment in Milgram’s work or institutional culture in the infamous Stanford Prison Experiment. (In this experiment, a fake prison was created on a university campus with participants divided into prisoners or wardens. It became such a toxic environment that it was called off after six days.)

But in 2016, a study by scientists from the Brussels’ Université libre de Bruxelles and University College London became one of the first to look not at what made people do bad things on command but what it felt like when they did.

In research published in Current Biology, scientists found that, when subjects were coerced or ordered to do something, they perceived a lag in the time between their decision and its consequence (in this case actual shocks or taking away money).

When people did these things of their free will, cause and effect were experienced more simultaneously – suggesting that people following orders felt less agency and even responsibility for their actions.

Researchers were reportedly quick to say that the work didn’t support the Nuremberg Defence.

And if humans are hardwired to pass the buck when we’re doing what we’re told, there may be few fields as dangerous as medicine – with its rigid hierarchies – for this to play out in.

The Rural Health Advocacy Project works with medical students and health workers to teach them to speak out for themselves and their patients. The costs for calling out your superiors are steep, the project’s Samantha Khan-Gilmore told Bhekisisa in 2016. From the moment that final-year students begin clinical rotations to when they begin their internships, Khan-Gilmore says they “experience a range of negative experiences at the hands of senior staff, most of which they believe are beyond their control”.

“They face tough choices about whether to stay quiet and support the status quo, or to speak up and risk victimisation. At the start of their careers, these healthcare professionals have a lot to lose,” she explains.

And when these medical students become professionals, speaking out becomes no easier. In fact, whistleblowers are often convinced that not even moving provinces will save them from the wrath – sometimes including physical threats – of superiors and peers should they report anything from abuse of overtime to surgery backlogs.

Meanwhile, anecdotal evidence from health workers suggests that regular performance appraisals, which could help workers and administrators accountable may be irregular and or vastly varying quality.

The Gauteng health department says that 100% of its employees have undergone performance appraisals in the past year and that results are loaded into its payroll systems. In fact, anyone below senior management is evaluated four times a year.

South Africa Medical Association chairperson Mzukisi Grootboom says this is surprising since complaints about the frequency and quality of performance appraisals are common among its members.

Today, the high-profile names whose “fingerprints were peppered throughout the project”, to quote the ombudsman, may be suspended but many more employees who had a hand in the Life Esidimeni tragedy remain in its employ – left to carry out future projects in the same organisational culture that allowed the scandal to happen.

And, to quote novelist and chemist CP Snow: “When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.”


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Vermiste pasiënt se lyk ná 2 weke in hospitaal-dak gekry

Die lyk van ’n pasiënt wat in die Stellenbosch- Provinsiale hospitaal behandeling ontvang het, is in ’n makabere voorval in die dak van die hospitaal gekry nadat hy sowat twee weke terug verdwyn het.

Die man (61), vermoedelik van die Paarl of Stellenbosch, was baie siek en deurmekaar toe hy twee weke gelede spoorloos uit een van die sale van die hospitaal verdwyn het.

Mark van der Heever, woordvoerder van die Wes-Kaapse departement van gesondheid, het die voorval bevestig.

Volgens Van der Heever was ’n verpleegster besig om die pasiënt te versorg toe sy skoonmaakmiddels moes gaan haal. Met haar terugkeer in die saal het die man spoorloos verdwyn.

Die hulp van die polisie is ingeroep en daar is oral in die hospitaal en omgewing na die vermiste man gesoek.

Van der Heever sê daar word tans bouwerk aan die hospitaal gedoen en van die boumateriaal was op die perseel. Daar is ook openings deur die plafon na die dak weens die bouwerk.

Ongelukkig was die man baie deurmekaar en het hy op ’n onverklaarbare manier in die dak beland op ’n plek wat moeilik bereikbaar is, het Van der Heever gesê.

Daar is Vrydag op die man se lyk afgekom.

Van der Heever sê die polisie en departement van gesondheid ondersoek die omstandighede rondom die voorval. Ondersteuning word gegee aan die man se familie en verpleegpersoneel van die hospitaal kry ook berading.

Deur: Netwerk24


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Obesity costs SA economy more than R700bn per year

Johannesburg – The economic impact of obesity in South Africa is more than R700bn per year, a study revealed.

According to the Discovery Vitality OBEcity index for 2017, which presents insights on weight status and food purchasing behavior of Vitality members across six South African cities, the impact of obesity is not only limited to the health of individuals but the economy too. The study covers the cities of Johannesburg, Pretoria, Cape Town, Durban, Bloemfontein and Port Elizabeth.

Obesity costs the global economy R16.4trn, which is roughly equal to the impact of smoking and wars. It costs the South African economy R701bn. It impacts productivity, which costs the economy R109bn each year. Increased absenteeism costs the South African economy R47bn, according to the report.

Other costs include increased medical spend, related to out-of-pocket healthcare costs, which amount to R124bn each year globally. Global figures also show that daily expenses cost obese people an additional R31bn.

Globally, statistics show that overweight women are predicted to earn 11% less than women of a healthy weight.

Among the contributors to obesity is increased consumption of sugar, salt, fat and animal products.

“Sales of ready-made meals, snack bars and instant noodles increased by 40% between 2005 and 2010,” the report read. “Fast food consumption continues to grow, negatively impacting our weight.”

Dr Craig Nossel, head of Vitality Wellness, explained that there is a direct correlation between weight status and wealth outcomes. “People with an unhealthy bodyweight incur a direct increase in healthcare costs of approximately R4 400 per person per year.”

Purchasing healthier foods has a positive impact on Body Mass Index (BMI) and R2 500 lower health costs per year, he added.

South Africa’s healthiest city

The study showed that Cape Town is the healthiest city, with 53.5% of Vitality members having a normal weight status. These people also purchase the most vegetables and fruit compared to other cities.

Johannesburg came second, with 52% of its members having normal weight and Durban placed third, with 51.8% of its members having normal weight.

“Port Elizabeth and Bloemfontein have the worst weight status, with 48.8% of residents having a healthy weight status in both cities,” the report read.

The report also showed that members in Durban and Port Elizabeth purchased the least portions of fruit and vegetables.


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Treatment waiting times continue to surge as KZN cancer services fail

Watch how waiting times for life-saving cancer treatment has grown as KwaZulu-Natal’s cancer services crumble. As the crisis grows, patients wait longer and longer for treatment. This information comes from the SAHRC’s report but Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka says he doubts the veracity of the information.

Keeka alleges the data does not reflect patient backlogs at Inkosi Albert Luthuli Central Hospital fuelled by a breakdown of treatment machines at Addington Hospital.

KwaZulu-Natal cancer patients are now waiting nine months for treatment, alleges Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka.

In a statement, Keeka said South African Human Rights Commission (SAHRC) chairperson Bongani Majola revealed this new information during a recent provincial health portfolio committee meeting. Previously, the average waiting time for treatment was seven months.

The news comes almost four months after the SAHRC released a scathing report detailing the collapse of cancer services in the province. The document accused the KwaZulu-Natal health department and its MEC, Sibongiseni Dhlomo, of failing patients.

After more than a year of investigation, SAHRC revealed that the province lost one oncologist each month over a five-month period. From October to December 2016, a breakdown in cancer treatment machines forced Durban’s Addington Hospital to refer its patients to the nearby Inkosi Albert Luthuli Central Hospital for treatment.

Durban lost its last public sector specialist in June, leaving only two such professionals in the province at Grey’s Hospital in Pietermaritzburg.

As of August, health minister Aaron Motsoaledi had launched a two-week plan to resuscitate cancer services, taking over some of the province’s procurement and human resources functions, said former national health department spokesperson Joe Maila at the time.


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Controversial billion rand mental hospital becoming white elephant

The DA is concerned that a number of factors are threatening the operationalization of the new mental hospital in Kimberley, placing it at a very possible risk of becoming a white elephant.

These factors include an obvious lack of funds coupled with internal management issues at the Northern Cape Health Department and within provincial government.
The new mental hospital, of which construction has been dragging on for more than 11 years already, remains at the centre of controversy for having time and again missed its completion dates and for non-stop escalating building costs.

A number of factors threatening the functioning of the facility, which is now due for completion early next year, were highlighted at a National Council of Provinces (NCOP) oversight visit to the facility yesterday:

– First and foremost is a total lack of funding for running costs for the facility, for which there is a shortfall of at least R240 million. So, until an allocation is made, either during the adjustment appropriation or even only in the 2018/2019 budget, the facility will have to stand unutilized;
– Secondly, is the fact that the Health Department is still placed under Section 18 of the PFMA, which in effect means that Provincial Treasury is holding the purse strings of this department. This could hamper operational decisions with regards to getting the facility up and running as speedily as possible; and
– Last, but not least, is the fact that there is still a moratorium on the filling of posts within the Health Department. Given the need for a big contingent of additional staff members to work within the new mental health hospital, this poses obvious challenges for the operationalization of the facility.

The DA is calling on Premier Sylvia Lucas to show leadership in the ongoing mental health hospital saga and to ensure that each of the above issues is urgently addressed to prevent any further delays in getting mental health care working in the Northern Cape. This is even more important now, given a submission yesterday by the ANC NCOP member Charl De Beer that the Free State would also be utilising Kimberley’s new mental hospital facilities.

It cannot be that a hospital, that has taken more than a decade to be completed at a cost of over a billion rand, runs the risk of becoming nothing more than a monument to corruption, while thousands of mentally ill patients in the Northern Cape and central South Africa are queuing up to receive treatment.

According to a study conducted by the London School of Economics and Political Science, 4.5 million South Africans suffer from depression. Many lives could be saved if access to treatment is extended.

The DA will continue to keep a close eye on further developments regarding the completion and operationalization of the new mental hospital.


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SA health sector faces a crisis

South Africa compares unfavourably with middle-income countries on the ratios of medical and dental professionals, and many districts have limited access to specialists and subspecialists.

Even South Africa’s private sector has fewer doctors per 100 000 people than most countries in the world.

A comprehensive report produced by Econex after a request from the Hospital Association of SA paints a bleak picture, especially in light of the planned National Health Insurance (NHI) scheme.

In 2013, there were just 25 state doctors and 92 private sector doctors per 100 000 people in South Africa.

The average is 60 per 100 000, while the world average is 152.

Even in India (70), Brazil (189) and China (194), there are more doctors per 100 000 people.

This is while pressure on South Africa is growing as a result of HIV/Aids, tuberculosis, violent crime, a high mortality rate among children younger than five, women who die during pregnancy, diabetes, heart disease and psychiatric illness.

The standard practice is that people visit their general practitioner three times a year.

If that was done locally, there would be a shortage of 4 100 doctors in the country, according to the report.

A constant increase in the number of trained doctors is necessary to meet the needs of the populace, which is growing at a rate of 1.58% a year.

It is uncertain how many doctors have emigrated, but between 2004 and 2009, 17% of doctors who qualified did not report for community service.

To be registered with the Health Professions Council of SA, you have to complete a year’s community service.

This could mean these doctors are leaving the country. Most South African doctors go to Canada, New Zealand, Australia, the US and the UK.

Between 70% and 80% of doctors also prefer not to work for the state.

The main reason for this is not poor pay, but poor working conditions.

Other reasons include a lack of equipment and medical provisions, a heavy workload, and insufficient protection against HIV and tuberculosis infections.

Foreign doctors, on the other hand, are eager to work in South Africa, but bureaucratic red tape prevents that. In the report, this is referred to as “severe delays and inefficiency by the Foreign Workforce Management Programme”.

In 2006, the department of health indicated that it wanted to increase the number of doctors who were being trained annually from about 1 300 to about 2 400, but nothing came of that.

In the meantime, Health Minister Aaron Motsoaledi said it was going to be increased to 3 600 in anticipation of the NHI scheme.

The plan is to train doctors in Cuba and China but according to the report, money is needed locally to train specialists.

It costs about R3.1 million per specialist and a post has to be available at one of the eight academic hospitals.

If private hospitals that serve as colleges also get accreditation for this, it would lighten the load considerably.

In India and Brazil, the model of private colleges has helped. In Brazil, training from the state is free, but students have to pay at private colleges.


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