Mail and Guardian,
By Nawaal Deane
the best medical scheme plan is a life-and-death choice if you are HIV-positive
and face long-term anti-retroviral treatment and extensive hospital bills.
Stevens*, whose partner died of Aids, says: "When we changed over to
another medical scheme we were promised full cover. But in the first three
months the annual savings allocated for our anti-retroviral medication ran
says the scheme only paid for the first eight days for his partner to be treated
in a hospice. "But what did they expect me to do for the ninth day?"
was forced to change to a scheme that offered more extensive coverage.
"Yes, it is an expensive scheme, but now I feel secure that my
anti-retroviral medication is paid for in full."
study by the Centre for Actuarial Research (Care) at the
study surveyed 77 open and restricted medical schemes with 5,29-million members.
McLeod, director of Care, says the study found that most of the medical schemes
it surveyed offer an extensive range of HIV/Aids benefits. The study says there
is more emphasis on prevention and education than treatment, but most medi-cal
schemes do cover at least some of the costs of anti-retroviral medicines,
treatment to prevent mother-to-child transmission of HIV and post-exposure
prophylaxis against HIV infection.
for HIV/Aids benefits is expensive, but the benefits may still not be adequate.
The study recommends that the structure and extent of benefits be investigated.
found that 81% of the options providing access to anti-retroviral medicines also
offer monitoring of the treatment and counselling.
has been a significant move towards triple-combination therapy as the optimal
anti-retroviral treatment. The study says 90% of beneficiaries have access to
triple-therapy treatment and only 9% have no access to any anti-retroviral
medication. "However ... the size of the benefit is ... inadequate for a
full year's supply of medication in many cases."
to prevent mother-to-child transmission of HIV is also extensively covered and
92% of beneficiaries have access to some form of anti-retrovirals. The
combination therapy of AZT and 3TC, or Combivir, is the most frequently used
treatment, but milk formula is provided to only 47% of beneficiaries.
study says medical schemes should try to provide more anti-retrovirals.
"The council of medical schemes should facilitate schemes to adopt a
guideline on anti-retroviral therapy that stipulates triple therapy as
treatment." It says generic medicines for opportunistic infections and
generic anti-retrovirals are essential to reduce prices.
study found disturbing evidence of low participation in the programmes, which
Care attributed to the medical schemes' inadequate marketing.
Geffen, spokesperson for the TAC, says HIV-positive people should choose a
medical scheme by carefully considering its benefits. They need to ensure that
the scheme covers triple combination therapy that is not paid out of a savings
scheme should provide about R1 500 for anti-retrovirals. "If they have a
spouse or family member that is also on anti-retroviral treatment, then the
scheme should cover them both."
* Name has been changed.