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Mediclinic News : Cover differs for various levels of depression calling for a review of benefits


Cover differs for various levels of depression calling for a review of benefits




News Description

THE NEW AGE The South African Society of Psychiatrists (Sasop) has criticised the medical cover of some mental health conditions over others under the prescribed minimum benefits (PMBs). It believes that the coverage puts those suffering from various mental conditions in a financially difficult place and may compromise their health. Sasop chairperson Mvuyiso Talatala said: "The fact that some mental health conditions are covered under PMBs while others are not is putting enormous financial pressure on patients to pay for their treatments out of pocket, creating a situation where many either stop their treatment or don't start in the first place, with catastrophic results for individuals with mental health issues. "In addition only certain treatments and medications are covered as part of the PMB structure, creating a situation where patients cannot possibly continue their journey towards a healthy mental state." According to Sasop about 30% of the population will suffer from mental illness at some point or another. Talatala said the fact that PMBs as set by the Medical Schemes Act 131 of 1998 has not been reviewed since 2004, and has seen some mental health conditions covered and others not was a "direct contradiction to how patients with other medical conditions are covered". "One could argue that this is due to the Department of Health waiting on the implementation of the new proposed National Health Insurance to rectify the situation but that would only delay the process even further," he said. He made a comparison between bipolar depression having full cover for both mood stabilising medication and antidepressants while major depressive disorder patients struggled to get antidepressants. Talatala said although all medical schemes paid for hospital admission of patients with major depressive disorder and bipolar depression up to 21 days prescribed by the Medical Schemes Act, the funding of out of hospital care was poor for both conditions. "Patients often end up going to the public sector for further treatment and the public sector hospitals are at liberty to charge these patients for further care. The biggest challenge faced by patients with bipolar depression and major depressive disorder is that they often have to pay for their treatment and medication in the public sector in spite of the PMB conditions," he said. He has recently lambasted the lack of funding for mental health in the private and public sector. "Primary health should be the entry point for mentally ill patients. However, without the necessary funding specifically dedicated for mental health, patients and their families will continue to suffer. Patients present late and even more severely ill, requiring hospitalisation. PMB came under sharp focus at the health inquiry with many organisations calling for them to be reviewed.
Created at 2016/09/01 10:16 AM by Mediclinic
Last modified at 2016/09/01 10:16 AM by Mediclinic