The SA Municipal Workers Union Medical Scheme (Samwumed) has dumped the Melomed Group from its list of approved hospitals, causing an outcry among members and forcing some Capetonians to travel up to 20km for healthcare.
Samwumed had announced last month that it would drop Melomed facilities from its list after failed attempts to negotiate an agreement with the National Hospital Network (NHN), which includes the Melomed Group.
The lack of agreement resulted in Samwumed terminating its agreement with the NHN and changing its approved hospital network for 2025, reports News24.
The move has frustrated and angered patients who previously used Melomed facilities
Ruth Petersen (63) said she and her husband joined Samwumed at the end of 2024 – a decision she would not have made had she known she would not be able to access a Melomed facility.
Her preferred doctors have been treating her for 15 years, and the Eerste River resident is hesitant to move to one who does not know her patient history.
Her husband (65) is now retired after working for the City of Cape Town for 44 years, and Petersen said they could not afford to chip in for the co-payments to keep seeing her regular, trusted doctor.
Strand resident Shanaaz Happie travels to Melomed Bellville for her children's paediatrician, whom she has been seeing for a decade.
She discovered the changes to her medical aid while at Melomed, waiting for a planned procedure for her 10-year-old daughter.
Her child had to be transferred to a nearby hospital for the procedure instead, leaving Happie stressing about meeting co-payments after the admission.
“At Melomed, I wouldn’t have had a co-payment. I know these other hospitals. I had a procedure at one, and it took me two years to pay off the co-payment.”
A Cape Town eye specialist, who asked not to be named, said he has been treating some patients for 20 years, and they would now have to look for a new doctor who operated at a hospital on Samwumed’s list.
“Out of the blue, someone decides it’s inconvenient to use Melomed and the reasons given are absolutely absurd.
“We live with the impacts of an apartheid society, where black people live in far-flung areas. Melomed went out of its way to build hospitals in those areas and now we’re telling patients they must travel to access healthcare in more affluent areas.”
The specialist said doctors in more affluent areas often charged above medical aid rates, which could place an additional financial burden on patients.
In addition, there were limited theatres with specialised equipment for carrying out eye surgeries, the doctor added.
Discussions over decision
The SA Municipal Workers’ Union’s general-secretary, Dumisane Magagula, said the union planned to engage the medical aid on the decision.
“We will be in touch with our structures and Samwumed’s principal officer. We have an arrangement that where there is one provider in the area, they should be accredited.
“Members can’t be travelling long distances to access healthcare outside their areas,” he added.
Samwumed’s chief operating officer, Philippa Escreet, said the agreement with the NHN, which began on 1 January 2021, had expired, and negotiation attempts for a new agreement were unsuccessful.
“Despite previous collaborations and participation in the 2023 request for proposals process resulting in the appointment of NHN as one of the anchor hospitals, no new network agreement has been signed with the NHN, because the parties could not reach a mutual agreement,” she said.
After the termination of the NHN agreement, Samwumed had “engaged with the Melomed Group to appoint its facilities most frequented by our members as filler hospitals in our network” but could not reach consensus.
“It should be made clear that neither the NHN Group nor the Melomed Group was prepared to come to a mutual agreement with Samwumed and that Samwumed had exhausted all avenues to reach a mutual agreement with them.”
The 2025 network includes alternatives like Netcare and Mediclinic, with specific recommendations for members previously using Melomed facilities.
For Samwumed members who previously visited Melomed Gatesville, the nearest approved hospital is 11km away, while those who used Melomed Mitchells Plain will have to travel 18km or 20km to the two nearest approved private hospitals.
However, Samwumed said that members who had received authorisation to receive treatment at an NHN or Melomed facility for the first quarter of 2025 would not have a co-payment.
A co-payment will only come into effect if they continue using these facilities from April.
In a statement, the NHN said the contract’s termination was unilateral and immediate, leaving limited options for recourse.
The group claimed the reasons for the termination were unfounded.
Escreet disputed that no competitive process was followed, saying a request for proposal (RFP) was issued in June 2023, and six hospital groups, including the NHN, had responded.
These proposals had been evaluated on predefined criteria outlined in the RFP, and the NHN and Netcare were identified as preferred providers.
The next step would have been to sign Samwumed’s standard agreement, which included a fraud prevention clause that requested participating health facilities to cooperate with the scheme during forensic investigations of these facilities or healthcare providers using these facilities, Escreet said.
However, the NHN declined to agree to the clause, saying it could not commit on behalf of healthcare providers.
Escreet added that the NHN had previously signed agreements with similar clauses.
“Samwumed provided the NHN with our standard agreement, accommodated their request to use a different contract and both parties agreed to an addendum to their previous contract.
“Netcare was comfortable signing our standard agreement …with a fraud prevention clause. NHN would not reconsider their stance and Samwumed exercised its rights in terms of the RFP clauses to cancel the network contracting process. As no contract was signed, the previous contract expired.”
She said Samwumed was puzzled by NHN’s stance on its fraud prevention clause, “which we have shared for transparency, as no direct obligations are placed on the health providers or health facilities themselves in this clause”.
Melomed spokesperson Shameema Adams said the announcement, sent late in December for implementation on 1 January 2025, created “severe challenges for patients who rely on Melomed’s accessible, community-centred healthcare”.
"This decision impacts the lives of real people, who now face daunting logistical and financial hurdles to access care.”
She said patients would now be forced to spend more time travelling, costing them money and time off work, to get private healthcare.
“This comes at a significant cost… also in their time and safety.
“For dialysis and cancer patients, the impact is devastating. Many are in the midst of complex treatment plans requiring continuity of care. Suddenly forcing them to switch to unfamiliar hospitals and specialists disrupts these lifesaving plans and adds immense stress to their already challenging circumstances.
“Cancer patients are left to re-establish trust and treatment strategies with specialists who have no prior knowledge of their cases.”
Adams said Melomed, which had partnered with Samwumed for more than two decades, was still inundated with patients expecting their usual chronic and acute care, as they have not been adequately informed about this decision.
She added that Samwumed had proposed retaining Melomed Gatesville and Melomed Mitchells Plain but this “is neither practical nor sustainable” due to “unrealistic travel requirements” and capacity challenges.
“Specialists at excluded hospitals cannot relocate without major disruptions, while Samwumed patients must now see new specialists who have no knowledge of their medical history.
"This is not just an operational issue. It is about the lived experiences of everyday South Africans struggling with disrupted access to healthcare in already vulnerable situations.
“Samwumed’s decision strips away choice and burdens patients in ways that undermine their health and well-being.”
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