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Cape Town - In an open letter to the Competition Commission, Cosatu has accused the South African healthcare industry and medical schemes of collusion with regards to the availability of cancer screening tests.
The high cost of the cancer screening test, combined with the use of certain testing companies only by particular medical schemes, “denies the country a greater ability to fight cancer and condemns those people who cannot afford it to a cruel death that could have been avoided in most instances”, writes Tony Ehrenreich, Western Cape provincial secretary of the Congress of South African Trade Unions.
In the letter, Cosatu mentions that “It has come to our attention that Discovery and some other medical aid companies are only using certain testing companies….The companies that are denied access to the testing for the medical aid companies led by Discovery are Unistell, Pathcare, Gene diagnostic, Ampath, who are willing to provide the test at a more affordable cost.”
This is simply not correct, according to Discovery Health principal officer Milton Streak. He responded as follows:
“Discovery Health Medical Scheme funds several genetic tests where the evidence confirms that these tests are cost effective and of proven clinical value. These tests are provided by both local and international pathology laboratories, and none of these funding arrangements are based on exclusive contracts.”
And on the issue of the cancer screening test?
“The main test that we are aware of that can currently accurately predict an increased risk of cancer is the BRCA genetic test, which predicts an increased risk of breast and ovarian cancer in some individuals. Discovery Health Medical Scheme funds this test from several providers including the National Health Laboratory Service.”
Inquiry into high cost of healthcare
There has been an ongoing inquiry by the Competition Commission into the reasons for the sharp rise in the cost of private healthcare. Medical inflation consistently outstrips consumer price index (CPI) inflation by about 4% per annum in South Africa. The Council for Medical Schemes announced in their 2014-2015 report that there had been an 11.6% increase in expenditure on hospitals from the previous year by medical schemes. CPI inflation for the corresponding period was 5% to 6%.
This is, however, not a phenomenon limited to South Africa, as medical inflation outstrips CPI inflation in many countries.
Genetic screening for cancer
Genetic screening for cancer is a relatively new concept. It is a test which finds mutations in the genes. These mutations can cause cells to grow out of control and lead to cancer, but only 5% to 10 % of cancers are thought to be related to an inherited gene mutation, says the American Cancer Society. Most of these gene mutations are caused by exposure to elements in the environment, such as tobacco and sunlight. So large-scale genetic screening of scheme members isn’t really done anywhere.
Genetic screening for cancer is often recommended if several family members of a patient have had a particular type of cancer. Many different types of tests are available. Breast cancer, ovarian cancer and pancreatic cancer screening tests are done most often.
Until now, this type of genetic screening has generally not been funded by the majority of medical schemes, certainly not the lower-cost options. These tests can be expensive and the cost can run into several thousand rands, in effect making them inaccessible to poorer people, as Ehrenreich states.
A call to your scheme administrators will quickly tell you whether they cover this option. In fact, actual diagnostic tests for many conditions besides cancer are not covered by the majority of medical schemes.
The whole exome screening test
But an export licence has not yet been granted to anyone by the Department of Health in regard to the particular testing mentioned (called exome-screening) in the letter from Cosatu. Human Longevity, the company mentioned as the provider of these tests, is based in the US and was co-founded by genomics pioneer Craig Venter, who despite his name, is not South African.
He does not seem to have connections with what is called the ‘white old boys' networks from apartheid days’ as mentioned in Ehrenreich’s letter to the Competition Commission. On being told this, Ehrenreich said he would investigate this matter and also the presence of Human Longevity Inc in South Africa.
In news reports from 2015 the hope was expressed that this particular test would be available by the second quarter of 2016, but this is not the case.
In reaction to the accusation concerning the high price of the cancer screening test by Human Longevity, Discovery Health CEO Dr Jonathan Broomberg pointed out that this test is not yet available in South Africa from Human Longevity or any other provider, and that it is not a test that is of current clinical value in predicting cancer, but rather in providing a comprehensive genetic profile.
He added the following: “The arrangement between Discovery Health and Human Longevity Inc relates to a whole exome screening test, which is being offered to members of Discovery Health Client Scheme who are interested in their genetic profile. Scheme members will pay for this test themselves.
“It will provide general genetic information, information on genetic traits, as well as some indications of increased risk of various conditions.
“The arrangement between HLI and Discovery Health has also not yet been implemented in South Africa, and as a result the test is not yet available in South Africa."
Network providers and medical schemes
Many medical schemes enter into contracts with certain doctors, hospital groups or medical service providers. This is often done in an attempt to limit costs to medical schemes and their members, as many of these networks agree to charge no more than the medical fund rate that the scheme will pay.
What this means is that members will not have to make any significant co-payments (ie extra charges) if they make use of certain network service providers.
The Competition Commission is investigating whether possible collusion between these service providers could be driving the high cost of private healthcare in South Africa.
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