Choosing a Medical Aid in South Africa




Do Medical Aid Companies Cover Superbug Treatment?  

In recent years the emergence of so-called “superbugs” has been the topic of many debates. Superbugs are germs that are generally found in hospitals. They do not react to antibiotics. In South Africa it is especially certain forms of E.Coli, Klebsiella and P.Aerugninos that is seen as a cause for concern. 

What is the origin of these superbugs? 

Medical Aid Companies and SuperbugsResearch has shown that the abuse of antibiotics is the main reason why superbugs develop. These germs often infect patients in hospitals and in many cases it is extremely difficult to rid the patient of the bacteria that infects his or her system. 

What medical scheme members what to know is: “If I am infected by a superbug, will my medical aid company pay for the subsequent treatment?” 

Unfortunately, the answer is that the entire issue is unclear. One thing is sure: this type of treatment does not occur on the Minimum Benefits list. It therefore follows that there is no law that obliges medical schemes to provide cover for the treatment of superbug infection. However, very few medical aid plans specifically exclude such treatment. 

What is the position of the medical schemes in South Africa? 

It would be reasonable to expect that the medical scheme can hardly hold a member responsible if the member is infected while undergoing authorized treatment at a hospital. However, many schemes will hold the specific hospital liable. This situation creates a vast grey area because most private hospitals will not admit that their patients are at risk of superbug infection. Hospitals argue that the very existence of these superbugs have nothing to do with efficient hospital management. 

One case in point: Recently, a dispute arose between Discovery Health and a private hospital because a member of Discovery contracted a superbug and required treatment. Eventually, the medical scheme and the hospital agreed to share the cost of treatment.Not all disputes are settled amicably and there are currently a number of cases before the courts where hospitals and medical schemes both refuse to accept the cost of treatment for superbug infection. 

The chairman of the Society for Clinical Microbiology in South Africa, Professor Nicol, has said that there is no clear idea of just how prevalent superbugs in South African hospitals are simply because there are no systems in place to monitor the issue. He also admitted that treatment is difficult because the bugs are carried in the intestines of the infected person. 

Professor Nicol also warned that there are now several bacteria that are resistant to drugs and that treatment is increasingly becoming difficult. He is of the opinion that, should these bugs become prevalent in hospitals; the South African health care industry will be facing an enormous crisis and there will be little that medical aid companies can do about it.

What should I do? 

Unless you are a member of a medical aid scheme you can forget about being compensated if you are infected by a superbug in a hospital. Becoming a member of a medical scheme is therefore the first step. You should also avoid visiting hospitals unless it is absolutely necessary. Superbugs are a reality and it is most certainly a cause for concern. © Medical Aid Plan