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What does the constitution and the Medical Schemes Act say about your rights to healthcare

In a deeply entitled culture in South Africa, many believe that they have certain rights permitted onto them due to wrongdoings in the past. The post “apartheid” generation feels like they have lost out on certain rights and that they should demand restitution of certain rights.

This, however, is not the case when it comes to healthcare. You do NOT have the basic right to Healthcare in South Africa. Our constitution is regarded as amongst the best in the world, yet, citizens still claim to have the right to healthcare. What does our remarkable constitution have to say about this?

Section 27(1)a of our constitution (https://www.gov.za/documents/constitution-republic-south-africa-1996) emphasizes that “Everyone has the right to have access to (a.) health care services”. 

That’s right, yes. You don’t have the basic right to healthcare, however, you have the basic right to ACCESS healthcare. What this encompasses is that, especially in our crippled economy, is that you may enter a healthcare facility but, proper healthcare is not guaranteed.

Like with everything in life, there is a twist to this ingenious section of our constitution. Section 27.3 of the same constitution stipulates that “No one may be refused emergency medical treatment”. That changes things a bit, doesn’t it?

So what is regarded as an emergency then? As this section in the constitution says, we may not be denied medical treatment at any healthcare facility during an emergency. Do you remember when last you bumped your small toe against the bedpost? Did you feel like you were dying and needed emergency healthcare? I’m sure we all went through that gruesome feeling at some stage in our life. If this was the case, and in accordance with our constitution, everybody would then be entitled to healthcare, and not only access to healthcare, right? 

Wrong! There is an Act that defines an emergency. This definition was embedded to prevent misconceptualizing of this section of the constitution and to prevent unsolicited visits to the ER. For an event to be interpreted as an “emergency”, the event needs to adhere to certain criteria. What does the Medical Schemes Act of 1998 say is an emergency? The Act defines an emergency as follows: “Regulation 7 of the Medical Schemes Act defines an emergency medical condition as the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide immediate medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy..”.( https://www.gov.za/sites/default/files/gcis_document/201409/a131-98.pdf).

What does this all mean and how does it relate to the constitution? In layman’s terms, it means that: in order to enjoy your basic right to access emergency medical care, your condition needs to be

  1. -Sudden and unexpected;
  2. –requires immediate medical attention;
  3. Failure to receive immediate medical treatment may result in loss of
    • Limb
    • Organ
    • Bodily function
    • Death.

In conclusion, no one has the basic right to healthcare unless during an emergency as defined by law. Regardless of whether you have insurance, medical scheme cover, or any other potential influencing factor, no one may be denied emergency medical treatment during an emergency medical condition. Private healthcare emergency care operations, ambulance services, and emergency rooms may not refuse treatment during an emergency condition. All emergency healthcare workers and ambulances are to take the patient to the nearest medical facility, regardless of whether it is a private or public institution. 

Will I be liable for the fees for services rendered at a private healthcare institution during an emergency? Hell yea! ☺ However, Private Healthcare Facilities fees are regulated for emergency admissions into the ER. They may not charge the patient normal private rates. They may only charge Prescribed Minimum Benefits as per the Act.

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