The majority of cancer patients living in South Africa experience heavy financial strains, in some instances bankruptcy, due to unforeseen medical costs associated with the medical condition.
According to stats from the National Cancer Registry (NCR), one in four South Africans are affected by cancer. More than 100 000 South Africans are diagnosed with cancer annually.
The costs for surgery, inpatient care, consultations and repetitive diagnostic and staging investigations have ratcheted up expenses exponentially, according to a report published in the South African Medical Journal in 2016. Due to these costs, medical aids are unable to cover many of the therapies and treatments.
The research highlights how new-generation immunotherapy drugs such as Ipilimumab, have a price tag of R1 million while an older drug like Trastuzumab costs R25 000 per treatment. A mastectomy plus Trastuzumab costs R500 000, and immunotherapy for metastatic melanoma R1 million.
Rough estimate of costs relating to cancer treatment in South Africa
|Breast biopsy||R17 000|
|Scans: bone, MRI, genetic testing||>R30 000|
|Reconstructive surgery||R50 000-R140 000|
|Hormonal therapy||R650-R2 500 per month|
|Chemotherapy||R25 000 for 4 cycles-R140 000 for 6 cycles|
|Radiation therapy||R51 000-R112 000 for 5 to 6 weeks of treatment|
Source: CANSA, Discovery Health
According to Melissa Wallace, head of research at CANSA, typical medical aid cover is inadequate for these expenses. There are additional medical costs that come with having cancer. Wallace highlighted that these costs include transport to treatment centres, accommodation near treatment centres, giving up work to care for a relative with cancer, losing your own job while undergoing treatment, managing side effects, managing rehabilitation, physiotherapy and basic lifestyle and diet changes.
Deon Theunis, head of distribution support at Sanlam Individual Life, said: “While it’s advisable for people to be prepared with medical aid, severe illness cover and other policies, it’s also vital for them to understand that the extent of the cost of cancer really only emerges when one understands these expenses and knows what a policy does and does not cover.”
Sanlam Individual life, issued a report that counts the hidden costs of having cancer:
Wigs: Hair loss is one of the side-effects of chemotherapy. PriceCheck suggests human hair wigs cost between R400 and R4 000 (the average being R1 000–R2 000). Some salons discount wigs to cancer patients and CANSA distributes wigs made from donated hair for free when available. The organisation also has a bank of acrylic wigs for patients to borrow from.
New clothes: Weight loss is common among cancer patients. It is advisable to get a few key clothing pieces during treatment and recovery that are well-fitted and are made from gentle, loose-fitting fabrics. About R3 000 should be set aside for clothes, including a variety of hats, slippers, a dressing gown and pajamas.
Dietary modifications: Dietary changes often depend on the patient and should be changed on the advice of a medical practitioner. Often there will be days when a patient loses their appetite, it’s good to keep healthy snacks and pre-packed small meals on hand. According to a recent food barometer you should budget around R2 500 per month for healthy food.
Transport, to and from appointments: Weekly appointments to various doctors and treatment centres can mean a lot of driving around or use of public transport. Petrol prices are fluctuating around R12.60 per litre. It’s advisable to measure distances and work out an estimate of cost per trip. Some small towns in the Eastern Cape and KwaZulu-Natal for instance, do not have cancer specialists. They often need to travel longer distances or budget for alternative accommodation to be closer to their treatment centres.
Household expenses: Other unexpected increases relate to general household expenses like water, electricity, the internet and telephone. With patients often at home more, all these costs escalate – costing up to R 1000 extra per month.
Complementary therapies: Some patients seek alternative holistic therapies like acupuncture as part of the recovery process and others may opt to see a psychologist for mental and emotional support. Appointments vary between R600 and R1 000 per session.
Home modifications: If an illness has an effect on a patient’s mobility or strength, it might be necessary to modify or renovate parts of the home to make it more easy to navigate. The scope of these modifications will vary – it may be as simple as making the bathroom floors non-slip and adding grab-bars for the shower, bath and toilet.
Home care: A live-in carer can cost R3 500 to R7 500 per month or more.
According to Theunis, the insurance industry’s claims statistics show that the likelihood of contracting cancer is far higher than any other disease. With that in mind, more medical scheme policies have to accommodate the heavy costs of cancer. It is also true that treatment and recovery weigh heavy on patients’ finances.
“The risk of falling into debt also becomes very high. There are very sad examples of families who have had to sell their homes and move in with family because of the exorbitant costs of treatment and recovery,” said Theunis.
Theunis says having a specific type of insurance, commonly referred to as “severe illness cover”, is the best way to manage the financial risks.
“This cover is different to medical aid, which covers doctors and hospital bills. Severe illness cover is intended to pay for medical aid shortfalls and expenses not usually paid by medical aid. It can also supplement reduced incomes when the illness is so debilitating that a career change or even stopping work is required, and in some cases, the benefit assists with experiences like a holiday, to help ease the emotional impact of the disease.”
The severe illness option was designed with consumers’ financial constraints in mind and as a means to help them reduce their costs instead of cancelling their policies in the current tight economic conditions.
“As tempting as it can be to cut insurance, the statistics are not in any of our favour, so being well prepared for cancer is really the best situation to be in,” said Theunis.
Discovery’s head of research and product development, Deon Kotze told Moneyweb that severe illness insurance provides lump sum benefits in the event of diagnosis with a severe illness (including cancer). Although these lump sums do not provide direct indemnification for the costs associated with the diagnosis, it assists with the treatment costs, or indirect costs as a result of the diagnosis (e.g. home nursing).
Gap cover policy from medical aid schemes also benefits the bank balance. According to Feroza Joosub, head of Sanlam Gap Cover, gap cover pays for the shortfall between what medical schemes pay for hospital procedures and certain out-patient services, and the tariffs charged by medical professionals.
“Having medical aid without gap cover can mean if something big happens you still have to cover a large portion of in-hospital fees. So, in our view, it remains a critical part of a person’s overall insurance cover,” Joosub said. However, given that gap cover typically pays up to 500% of medical scheme rates and that gap cover payments are now capped at R150 000 per beneficiary per year, severe illness cover can go a long way to cover out-of-pocket medical costs too.
CANSA provides support for cancer patients and survivors by offering free wigs, stoma bags and linen savers, home-based support, lymphedema treatment, and assistive devices and medical loan equipment via its care centres.