CAPE TOWN, 18th JUNE 2015: On Thursday, 18 June 2015, the application launched by Treatment Action Campaign (TAC), South African Depression & Anxiety Group (SADAG) and People Living with Cancer (PLWC) to intervene as amici curiae (“friends of the court”) in a matter concerning patient rights will be heard in the Western Cape High Court.
In September 2014, Genesis Medical Scheme (“Genesis”) launched an application against the Minister of Health, asking the Western Cape High Court to review and set aside regulations that provide for the prescribed minimum benefit (PMB), which are made by the Minister in terms of the Medical Schemes Act (“the Act”). If Genesis were successful, patients would suffer and their rights would potentially be violated.
The Minister has not opposed the application. However, a number of other interested parties have applied to the court to join the case as Respondents. These include the Council for Medical Schemes, Hospital Association of South Africa, South African Private Practitioners Forum, Multiple Sclerosis Society of South Africa and Infertility Awareness Association of South Africa. The court will hear all these parties on Thursday.
TAC, SADAG and PLWC are all patient advocacy groups involved in promoting access to treatment, care and support for patients with HIV/AIDS, mental illnesses and various forms of cancer both in the public and private health sectors in South Africa. The Prescribed Minimum Benefits or PMBs are a defined set of benefits aimed at ensuring all medical scheme members have access to certain minimum health care services regardless of the benefit option they have selected. PMBs include chronic illness such as asthma, diabetes, epilepsy, as well as all emergency medical conditions. The costs of diagnosis, treatment and care of PMB conditions, including HIV, TB, and several mental health conditions and cancers must be paid in full by medical schemes. This means that the patient does not have to pay out-of-pocket or out of their Medical Savings Account for these conditions. The objective is to provide for with continuous care and ensure that members do not run out of benefits for the specified medical conditions. This is meant to protect the right of everyone to have access health care services.
Genesis is asking the Western Cape High Court to review and set aside the PMB regulation on the basis that the regulations are “ultra vires” the Ministers powers (in other words the Minister does not have the power to make the regulations). Genesis believes that the Minister is only empowered to prescribe medical conditions in the Regulations and not how medical schemes are required to pay for the treatment of these conditions.
TAC, SADAG and PLWC believe that the Minister does have the power to regulate the medical schemes by requiring the payment of PMB conditions in full and without co-payments or deductions. TAC, SADAG and PLWC argue that patients’ right to have access to health care services is key to determining this challenge.
The TAC’s Anele Yawa explained: “TAC has always fought for affordable treatment for patients living with HIV/AIDS and TB. The public sector is already over-burdened, with frequent stockouts of life saving ARVs. Removing the PMB regulations will only further burden the public sector, where 5 million people currently access their treatment”.
Cassey Chambers of SADAG said: the organisation is very concerned about the removal of the requirement to pay in full. “Many patients with mental health conditions will not be able to afford to pay or co-pay for the medicines they need and will land up in hospital with even more serious conditions”.
Linda Greef of PLWC said: “many cancer treatments will simply be out of reach for anyone without the guarantee of payment for PMB conditions related to cancer”.
TAC, SADAG and PLWC are represented in this matter by SECTION27.
For more information please contact:
Cassey Chambers, South African Depression & Anxiety Group 082 835 7650
Linda Greeff, People Living with Cancer 082 551 3310
Marcus Low, Treatment Action Campaign 082 962 8309
Umunyana Rugege (Attorney), SECTION27 083 458 5677