health care discrimination against the mentally ill. A comparison of private health insurance benefits for major depressive disorder and ischaemic heart disease in South Africa.

Piet Oosthuizen, Olge Scholtz, Charmaine Hugo, Belinda Richards, Robin Emsley

SUMMARY

Objectives
To compare the benefits available for the treatment of psychiatric and general medical disorders in the private health care industry in South Africa.

Design
A descriptive study of inpatient, outpatient and chronic medication benefits available for the treatment of Ischaemic Heart Disease (IHD) vs. Major Depressive Disorder (MDD) to members of open medical schemes in South Africa.

Subjects
All open medical schemes in South Africa with information available in the public domain and accessible via an Internet website.

Results
Fifty-seven schemes offering 130 options were included in the analysis.

Notwithstanding the fact that the global disease burden of MDD is greater than that of IHD, there is, at our most conservative estimate, a TWENTYFOLD greater benefit availability for the inpatient treatment of IHD than that for the treatment of MDD in private health-care settings in South Africa.

In fact, the vast majority of the options that we considered placed no limitations on the inpatient treatment of IHD whereas in most cases there were severe restrictions placed on the treatment of MDD. Although this was the most prominent discrepancy, outpatient benefits and even chronic medication benefits showed discriminatory funding policies, albeit not to the same degree.

The Bill of Rights of the Republic of South Africa specifies people with disability as one of the groups that may not be discriminated against. It goes on to state 'National legislation must be enacted to prevent or prohibit unfair discrimination.' Psychiatric disorders are included among these disabilities. Section 10(1) of the recently approved Mental Health Care Act of South Africa states "A mental health care user may not be unfairly discriminated against on the grounds of his or her mental health status. ". Despite these legal safeguards, discriminatory practices continue unabated.

Conclusions
Despite the emphasis in the constitution on equity, private healthcare funders in South Africa provide far greater benefits for the treatment of IHD than for the treatment of MDD. Health professionals, in conjunction with consumer advocacy groups, should address this issue without delay.