Discovery Health Medical Scheme response to misleading article in The Star “Life vs Medical Scheme”

Discovery Health Medical Scheme is aware of an article published in The Star newspaper of 8 August on one of our members, Ms Thobeka Xaba, and our support for her during her cancer treatment.  The article misrepresents Discovery Health Medical Scheme’s support for Ms Xaba during her six-year long battle with cancer and we would like to give the correct facts of the case.

Discovery Health Medical Scheme has always put Ms Xaba’s health first, having funded her cancer treatment in full for the past six years until earlier in the year, when her oncologist requested a new treatment.

Evaluating new healthcare treatments is complex, and Discovery Health Medical Scheme’s approach is to defer to the leading independent experts in the field to ensure that the care our members receive is the best and most appropriate.  We hence referred Ms Xaba’s case to leading academic oncology specialists to review and give advice on whether the new treatment should be covered. The feedback from this panel was clear – that there is no published clinical evidence that the drug would be effective or safe for this patient’s condition, and that there are other safe and effective treatments, which would be covered in full by Discovery Health Medical Scheme.

Importantly, the decision was not a financial one, but one that places Ms Xaba’s health as the top priority. On this basis, Discovery Health Medical Scheme proposed more expensive treatment regimens as alternatives that we would cover in full. Contrary to what was reported in the Star article on 8 August, Discovery Health Medical Scheme did not recommend that Ms Xaba continue on the prior medication which her doctor wished to stop. The recommendations from the Scheme were for new alternatives that would be funded in full, and for which there was clear evidence.  

Oncology treatment regimens are complex, and Discovery Health was at all times open to engaging with Ms Xaba’s doctor to find the appropriate solution that would achieve the best quality of care for our member. 

The case was referred to the Council for Medical Schemes for resolution. Earlier today, Discovery Health Medical Scheme attended an appeals hearing at the Council for Medical Schemes which was convened on an urgent basis. Whilst the appeal ruling is awaited, the following came to light during the appeal hearing:

• Ms Xaba’s treating oncologist immediately conceded that the treatments that Discovery Health Medical Scheme had been suggesting were acceptable, and that her patient could be treated with these immediately.
  
• She also conceded that she is not up to date with the South African Oncology Consortium medicine tiers and protocols. She was unable to give an adequate explanation of why she refused to discuss these alternatives with her patient and Discovery Health Medical Scheme for over two months.  
  
• The oncologist acknowledged that she had not advised the media and Discovery Health Medical Scheme regarding the treatment Ms Xaba has been receiving. Whereas the doctor told the media that the patient had not been on any treatment for the past two months, and that her life was in danger, the doctor today told the hearing that the patient had in fact been on treatment over this whole period.
  
• It is clear that this medication was inappropriate based on the views of some of the country’s leading experts.
  

Discovery Health Medical Scheme has reconfirmed to Ms Xaba that her treatment plan recommended by our independent specialist panel will be funded in full, as it has been for the past six years. We are pleased to confirm that Ms Xaba will now recommence the appropriate treatment and we will continue to support her to the best of our ability.

More about Discovery Health Medical Scheme’s cover for cancer treatment

Discovery Health Medical Scheme offers the most comprehensive cancer treatment programme of any medical scheme in South Africa

Cancer affects millions of people in South Africa, and as one of the largest healthcare funders in our country, we offer the most comprehensive cancer treatment programme in South Africa.

We currently have over 35 000 members in our care who are undergoing cancer treatment. Over the past year Discovery Health Medical Scheme covered over R1 billion of cancer treatment for our members with 99% of treatment covered in full. In addition, we covered R1.3 billion of non-cancer treatment for our cancer patients.

We make funding decisions based on the best clinical advice and evidence available in the industry

As a healthcare funder, our primary responsibility is always to protect our members and do what is right for them. This means ensuring that members receive appropriate medical treatment according to the benefits on their plan. In cases where exceptions are made, these decisions about funding must be made according to the best clinical evidence that is available. It is important to understand that as medicine become more complex – not only in South Africa but also globally – healthcare professionals and health systems are continuously working to use the best available clinical evidence and protocols to determine what type of treatments will be effective for which conditions. This is particularly important for cancer treatment, where science and technology are evolving at a very fast rate. This makes it difficult to for individual healthcare professionals to remain abreast of the latest clinical evidence.