SECTION27 encourages the South African public, the media and civil society to attend the High Court hearing in the case between Netcare and KPMG and the Competition Commission. This hearing will take place at the South Gauteng High Court in Johannesburg beginning at 10h00 on Tuesday 20 May to Thursday 22 Continue Reading
SECTION27 and Corruption Watch are hosting a civil society stakeholder meeting into the Competition Commission’s Market Inquiry into the Private Health Care Sector. Tim Fish Hodgson and Janneke Saltner’s presentation has been attached below. The Competition Commission has also released important dates for the Health Inquiry. These have also been Continue Reading
SECTION27 has developed a fact sheet into the Market Inquiry. This publication is an easily accessible guide to the Inquiry which explains its importance. This publication has been produced ahead of the civil society consultation that the organisation is hosting in partnership with Corruption Watch on 15 April 2014 at Continue Reading
SECTION27 WELCOMES THE RELEASE OF THE FINAL TERMS OF REFERENCE FOR THE COMPETITION COMMISSION’S HEALTH INQUIRY Introduction On Friday, 29 November 2013, the Competition Commission published the Final Terms of Reference for the inquiry into the private health sector (TOR). The publishing of this document follows from a period of Continue Reading
SECTION27’s Umunyana Rugege gave a presentation on PMBs at the Libcare PMB workshop on the 15th of August. Please find it attached. Umunyana Rugege PMB presentation Part of the message of thanks received afterwards read: “On behalf of the Libcare Board of Trustees – sincerely thank you for participating in our PMB Continue Reading
SECTION27 has sent a submission to the Competition Commission on the draft Terms of Reference for the Market Inquiry into the Private Health care Sector . It was endorsed by the Black Sash and by the Rural Health Advocacy Project. SECTION27’s recent submission to the Health Professions Council of South Africa in Continue Reading
SECTION27 and TAC welcome the announcement by Minister Ebrahim Patel that the Competition Commission will launch a market inquiry into the private healthcare sector in September 2013.
SECTION27 welcomes the promulgation of section 6 of the Competition Amendment Act 1 of 2009 (“Amendment Act”) by proclamation published in the Government Gazette on Friday, 8 February 2013. The proclamation brings into force the provisions related to a market inquiry, which will come into force on 1 April 2013.
Out of concern for the possible dilution of the right of health protection through medical schemes, a letter has been sent by civil society organisations, in the form of SECTION27, the Helen Suzman Foundation, and the Chair of Social Security at Wits University, to the Ministers of Finance and of Health.
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.