Doctors and medical practitioners across the country are refusing to treat Compensation Fund patients because of the failure by the fund to settle their claims, research undertaken on behalf of the Democratic Alliance (DA) has shown. Business Day reports that even more alarming, the party says is that government hospitals have also turned patients away because of non-payment.
The DA has urged government to outsource the administration of the R52bn fund which has been plagued for years by inefficiency to the private sector which has the proven capacity to undertake the work. The fund was established to provide compensation for workers injured or made ill at work but the DA says it is failing in its task because it does not have the required IT and human capacity to undertake it.
The DA's research followed the recent announcement by pre-funder Compsol that it could no longer pay doctors and medical practitioners in advance of the payout by the Compensation Fund because of the huge sums owed to the company by the fund. As at end-April the fund owed R556,000 to Compsol's members. The inability of the fund's IT system to process claims meant that 91,000 of its claims had been rejected.
The research was conducted by the South African Medical Association (Sama), National Employers Association of South Africa (Neasa), Independent Practitioners Association Foundation (Ipaf) and Qualicare, an association of doctors in the Western Cape. The over 1,200 individuals – doctors, hospital staff, and employees – surveyed confirmed that many doctors and medical practitioners were not being paid for treatment and care given to injured workers.
Of the 640 employees surveyed by Neasa, 254 (39.69%) had at least on one occasion been turned away by a doctor due to their case being Compensation Fund related. In addition, a total of 14.5% of injured employees said they had been turned away by government hospitals as well. Qualicare found that about 65% (200 out of 300) doctors said they would not attend to Compensation Fund patients.
DA MP Michael Baigram noted in the report that all workers made mandatory monthly contributions to the fund but were not receiving the medical cover they paid for. "The Compensation Fund has become one the greatest barriers to medical care for injured South African workers. The institution has always been a slow lumbering giant, and is getting worse with each passing day," Baigram said.
A SABC News report quotes the DA's spokesperson for Labour, Ian Ollis as saying patients are suffering. He adds, "Just under 40% have at least once been turned away by doctors, 14.5% have claimed even been turned away at government hospitals. And that is astounding."
The fund is reported to have R52bn in the bank and Ollis says the root of the problem is the failing administrative system. The spokesperson for the Compensation Fund, Xola Mnene, says they would want more time to study the DA's survey before commenting.
The auditor general gave the fund's financial statements a disclaimer of opinion for reasons including poor accounting records and lack of internal controls, reports News24. "The financial statements as a whole are materially misstated due to the cumulative effect of numerous individually immaterial uncorrected misstatements in… the statement of financial position, the statement of financial performance and the notes to the financial statements," he wrote in the report.
According to the financial statements, R2.7bn in benefits were paid in the 2013/14 financial year, and R1.9bn the previous year. The auditor general, however, cast doubt on the accuracy of these figures. "The entity did not have adequate internal controls to maintain records of benefits paid. Therefore, I was unable to obtain sufficient appropriate audit evidence to substantiate whether management has correctly accounted for all the claims for the current and prior year," he wrote.
The Labour Department's director-general, Thobile Lamati, said he doesn't agree with the DA's call for the partial privatisation of the fund. According to an Eyewitness News report, Lamati said his department will soon be announcing measures to turn the fund around.
"And the key to that (turnaround) is to provide the fund with the necessary skills and competencies it requires to adjudicate and process the claims within the prescribed timeframes so I am convinced we will turn around the Compensation Fund," Lamati is quoted as saying
The department aims to settle a backlog of 231,000 claims by the end of next month. Also, a new electronic management system was introduced last year, the latest in a string of system changes.
[link url="http://www.bdlive.co.za/business/healthcare/2015/05/18/sa-compensation-fund-patients-getting-a-raw-deal"]Full Business Day report[/link]
[link url="http://www.sabc.co.za/news/a/eea9e280486bb714af17afb203cf1740/Compensation-fund-patients-are-being-shown-the-door:-DA-20151805"]Full SABC News report[/link]
[link url="http://www.da.org.za/2015/05/doctors-refusing-to-treat-injured-employees-due-to-calamitous-compensation-fund/"]DA statement[/link]
[link url="http://www.news24.com/SouthAfrica/News/Compensation-Fund-in-shambles-DA-20150518"]Full News24 report[/link]
[link url="http://ewn.co.za/2015/05/19/Labour-Department-disagrees-with-calls-to-partially-privatise-Compensation-Fund"]Full Eyewitness News report[/link]