South African Health Department seeks alternative medicines due to drug shortage

As South Africans consider medical insurance options for 2027, a critically important question is often overlooked: does the chosen plan cover treatment at the private hospital they actually want to use?

For many families in Cape Town, choosing medical insurance usually begins with comparing monthly premiums, followed by reviewing coverage for chronic diseases and daily expenses. However, there is another factor that can lead to serious financial consequences—the hospital network tied to a specific medical insurance plan.

Family membership in a well-known medical scheme and regular premium payments do not guarantee unlimited access to all private hospitals; this distinction is significant.

The Discovery Health medical scheme offers various hospital placement schemes depending on the selected benefits options. Members of certain Smart, Delta, and KeyCare plans are required to use specified hospital networks for planned hospitalizations. Other options provide broader hospital access, provided the scheme rules and authorization requirements are met.

For example, a member of the Discovery KeyCare plan cannot automatically assume that every private hospital in Cape Town will be covered for a planned procedure. Similarly, members of Delta plans must consider the financial implications of choosing hospitals outside the applicable network. These conditions mean that two Discovery members living in the same suburb may have different hospital choice options due to belonging to different benefit plans.

Before selecting a plan for 2027, members should check the current hospital network rather than relying solely on the name of the scheme.

Bestmed also differentiates between benefit plans with different hospital placement schemes. The Beat and Rhythm network options have specific lists of hospitals that members should review when planning treatment. Bestmed has published the hospital list for 2027 for these options.

For Cape Town residents, the practical question is whether their preferred facility is on the list applicable to their specific plan. A member who regularly visits a particular hospital must check its network status before changing benefit plans. Hospital participation can vary between options, and access should never be taken for granted just because the facility belongs to a recognized group of private hospitals.

Cape Town residents in areas such as Durbanville, Bellville, Milnerton, Claremont, Rondebosch, and Constantia have access to private hospitals managed by Mediclinic, Netcare, Life Healthcare, and other providers. Nevertheless, not all hospitals are included in all medical insurance networks. Families must ensure that their preferred hospital is covered under their specific plan and check whether surgeons, anesthetists, and specialists charge rates higher than those set by the scheme, which could potentially lead to out-of-pocket expenses.

According to Adrian Schoman from MedicalAid.com, hospital access is an important aspect when comparing medical insurance options. He notes: 'Monthly premiums can be relatively easily compared. Understanding the limitations associated with these premiums requires closer attention. A lower-cost network option can provide adequate coverage for a family whose preferred hospitals and healthcare providers are part of that network.'

However, the same option may be less suitable for someone who needs access to a specific hospital or specialist. The practical takeaway is that families should compare the hospitals they can actually use, not just compare the stated level of hospital coverage.

A medical insurance plan should be evaluated based on the medical facilities and services that the household is likely to need.

Planned hospitalizations and emergency medical care are treated differently. Under South Africa's Minimum Benefits Package (PMB) regulations, medical schemes are obliged to fully fund qualified emergency treatment, even if members unintentionally seek services from out-of-network providers.

According to the Council for Medical Schemes, this protection may also apply when designated providers are unavailable or access is unreasonably delayed. However, not every visit to an emergency room qualifies as a PMB emergency. Members should follow their scheme's authorization procedures whenever reasonably possible.

What consumers should do before choosing a plan for 2027

Before choosing a medical insurance option, families in Cape Town must confirm that their preferred hospitals are included in the scheme's network. They need to check pre-authorization requirements, co-payments for out-of-network services, and reimbursement rates for specialists. Written confirmation of hospital coverage should be obtained before planned treatment.

The best medical plan is not necessarily the cheapest or the one offering the broadest stated benefits, but the one that provides appropriate access to healthcare, financial protection, and value for money.

The Council of Ministers of Mozambique confirmed that the country has sufficient supplies of essential medicines for the next two years, despite persistent reports of drug and reagent shortages in various health units.

Inocêncio Impissa, spokesperson for the Council of Ministers, declared during the 31st ordinary session of the body, held in Maputo, that after receiving all requests, there will be no problems with the lack of basic medicines for at least the next two years.

Impissa informed that the first batch of medicines purchased by the health sector has already been received and that new shipments are expected soon. He admitted that temporary disparities in medicine availability may occur between provinces, districts, or health units due to the ongoing distribution process.

The spokesperson stressed that the overall supply of the system is guaranteed, adding that districts closest to the provincial medicine depot should already be receiving the items. The guarantee extends to vital medicines for the normal functioning of public health services and personal protective equipment, as requested by professionals.

The situation of interruption of health services in Mozambique, caused by frequent failures of essential medicines and supplies, occurs at a time of system fragility due to cuts in external funding, according to a report released in September.

This alert comes from a report by the Mozambique Health Cluster, a coordination platform for humanitarian assistance in the health sector, coordinated by the World Health Organization (WHO) and involving UN agencies and other entities operating on the ground, especially in Cabo Delgado, in northern Mozambique.

The document entitled 'Medicine Supply Chain in Mozambique: Ensuring Supply Amid Funding Uncertainty' points out that 79% of interviewed organizations reported constant or recurring absences of medicines and other crucial products in health units. Furthermore, half of these organizations indicated that such disruptions exceed one month.

Among the most affected items are antibiotics, analgesics, contraceptives, gloves, and wound dressings. Those responsible for the report warn that this scarcity not only leads to delays in care but often results in the complete paralysis of services for patients.

The study's authors advocate for greater articulation among donors, more stable funding for the entire medical supply chain, and support for migration to national funding sources, aiming to reduce dependence on external aid and ensure greater stability in population access to healthcare and medicines.