CARDIOLOGISTS say they struggle to do their jobs because of resistance from medical schemes, and end up having to fight their patients’ battles.
This came on the third day of the Health Market Inquiry, on Thursday, as the South African Society of Cardiovascular Intervention made its oral submissions.
Dr David Kettles said cardiologists often found themselves fighting their patients’ medical schemes to pay for their healthcare.
He runs his own practice and said he often found himself sending requests to medical schemes that read as follows: "Please sir, I promise you a pacemaker is really necessary," and "You need an anaesthetic to do a bypass operation."
Dr Kettles said medical schemes also controlled the type of operations that were performed on their members and which medication they could take. This was because they would pay only for certain procedures and medications.
Because of medical schemes’ resistance to funding the medication, they often ended up paying more for drugs that were sometimes inferior, rather than give in and pay for other medication, he said.
"My integrity as a practitioner is threatened (as a result). None of my patents can afford to have an opinion, nor can I." Dr Kettles called the actions of the schemes "coercive in the extreme".
Often procedures were delayed by repeated requests for cardiologists to motivate why their patients need a particular operation or medication. He said because of the constant back and forth questions, which are a deliberate delaying tactic, "patients (suffer) irreversible harm and sometimes death".
Dr Kettles said he believed it was his responsibility as a doctor to inform his patients of their rights, and therefore did so in his practice.
Earlier the inquiry heard from Michael Herbst, who made a submission on behalf of the Cancer Association of SA.
Prof Herbst also said prescribed minimum benefits (PMBs), a list of 270 diseases and 27 chronic conditions that medical schemes are obliged to cover in full, needed to be reviewed.
The onerous PMBs have been a big concern for many people, who have made submissions on them since the inquiry started on Tuesday.
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