POS0020-PARE THE ROAD TO INCLUSION FOR AXIAL SPONDYLOARTHRITIS IN SOUTH AFRICA
Authors: M. Van Dam
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In South Africa, the healthcare system is characterized by a clear division into two tiers, which unfortunately results in significant inequality. The public sector faces chronic underfunding, posing numerous challenges in providing adequate healthcare services. This disparity in access to healthcare remains a critical concern for patients with rheumatic diseases. The Council for Medical Schemes (CMS) operates as a statutory body, with the primary objective of regulating private health financing through medical schemes. Prescribed Minimum Benefits (PMB's) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. This benefit is not available to patients with Axial Spondyloarthritis. (AxSpa) PMB's are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care. This process should be reviewed every 2 years. This has not been reviewed since 2013. In view of the severe consequences associated with the ineffective treatment of AxSpa, the lack of access for patients seeking treatment in AxSpa as a PMB undoubtedly violates a patient's constitutional rights to equality, human dignity, life and access to adequate health care. <h3>Objectives:</h3> Our objectives is to challenge the CMS to review this process and the catastrophic exclusion of AxSpA on the PMB List. The outcome would be whether they reviewed the process. <h3>Methods:</h3> In order to challenge the CMS we design an "Ask document" and present it to an appeal committee. These documents were based on 3 phases: The first phase was finding possible loopholes in the reasons why AxSpA could have been excluded if you look at the similarities in treatment options between RA, JIA and AxSpA with a team of rheumatologists. The second phase was to get industry and funding support to gain access to legal support that we would need to state our case. The third phase involved finding the similarities between the disease areas and proving that a grave mistake has been made leaving AxSpA from this list. The team that worked with ASASA (The Axial Spondyloarthritis Association of South Africa) consisted of the patient organisation that represents 1000 patients, a team of 3 rheumatologists and a legal team. <h3>Results:</h3> We have pointed to the inconsistencies on the inclusion of other conditions, related to AS, in the PMBs, but AS being excluded. We have also pointed to the fact that AxSpa is a PMB condition when a person is a child as juvenile idiopathic arthritis, but does not remain so when a person reaches adulthood. The comorbidities of rheumatoid arthritis (a PMB condition) and AxSpa, are exactly the same. <h3>Conclusion:</h3> Finding loopholes in the reasoning allows for AxSpA diseases that face inequities to be reviewed. As of 16 December 2023, this matter is still in the appeal court of the CMS awaiting an outcome. <h3>REFERENCES:</h3> [1] https://www.wits.ac.za/news/latest-news/opinion/2021/2021-07/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency.html [2] https://www.medicalschemes.co.za/about-cms/ [3] https://www.medicalschemes.co.za/resources/pmb/pmb-conditions/ <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>