SECTION27 is a public interest law centre that seeks to influence, develop and use the law to protect, promote and advance human rights. Our name is drawn from the section in the South African Constitution which enshrines everyone's right to health care, food, water and social security.
Yesterday, SECTION27 responded to the “Draft Regulations Relating to the Categorisation of Hospitals” issued by the Minister of Health on 12 August 2011. The regulations aim to comprehensively categorise hospitals; if drafted properly they will improve health care service provision, offer important guidelines to health care providers and enable civil society to hold hospitals and government accountable.
Unfortunately, shortcomings in the draft regulations render them incapable of fulfilling this potential without significant revision.
The submission, sent to the Director-General of Health on 11 October 2011, identifies numerous shortcomings in the draft regulations.
SECTION27 and the Treatment Action Campaign (TAC) welcome the release of the Green Paper on National Health Insurance (NHI) for public comment. As organisations committed to the realisation of the right of everyone to have access to health care services, as guaranteed in section 27 of the Constitution, we value the opportunity to participate in what appears to be a clearly defined and well-considered policy development and implementation process that is to be accompanied and underpinned by legislative reform.
SECTION27 is becoming increasingly aware that some medical schemes try to narrow the scope of the benefit options they offer when it comes to processing claims. This may be done, for example, by mischaracterising claims so that they fall outside benefit options, improperly imposing late joiner penalties and waiting periods, or failing to cover prescribed minimum benefits as required by law. Such practices are unlawful and violate the rights of scheme members who are forced to incur out-of-pocket medical expenses in circumstances where they are covered by their benefit options. In some cases, they may also be prevented from accessing necessary health care.
Our client, IE, has been HIV positive for 20 years and participated in early trials of antiretroviral (ARV) medicines before the conventional treatment regimens became available. As a result of his exposure to various ARV medicines and regimens over an extended period, IE began to develop fatty growths on his back and neck and was diagnosed with ARV-related lipodystrophy. On the recommendation of his physician, IE applied to Bonitas Medical Fund (Bonitas) for authorisation for the surgical removal of the fatty growths on his body.
Bonitas, however, refused to cover the medical procedure on the basis that it considered the procedure to be cosmetic surgery. There was no medical basis for this decision. Bonitas failed to consider all the relevant information before it and mischaracterised the claim as cosmetic in order to avoid its legal obligation to cover IE’s costs. Following SECTION27’s intervention on behalf of IE, the claim was authorised with retrospective effect and IE was reimbursed most of his out-of-pocket expenses.
Many people living with HIV continue to face unfair discrimination in various aspects of their lives. SECTION27 often receives reports from people who are denied access to insurance products solely on the basis that they are HIV positive, or are offered cover at what appear to be highly inflated prices.
SECTION27 recently met with representatives of the Association for Savings and Investment South Africa (ASISA) to raise concerns we have regarding the current approaches and practices of the insurance industry in relation to HIV.