Melomed Private Hospitals and its specialists have been informed that they have been excluded as service providers for the South African Municipal Workers Union Medical Scheme (SAMWUMED), with immediate effect.
The decision by SAMWUMED will undoubtedly impact a number of patients and communities in the Cape Flats and surrounding areas of the Western Cape.
IOL understands there are at least 60 cancer patients who already have treatment plans scheduled at Melomed Hospitals for the new year who will now be unable to continue their treatments. Specialists speaking to IOL on condition of anonymity said in some cases, there are Stage 4 cancer patients whose diseases are being kept under control, but without treatment, the specialists are concerned the patients' lives will be at stake.
"These are really lovely people. I always put my patients first. Some of them have been in my care for years, and now I will have to turn them away. Where can they turn to?" one specialist told IOL.
Melomed Hospitals have provided care to SAMWUMED members for over 20 years and according to Shameema Adams, the Group Marketing Manager of Melomed this decision took “everyone by surprise”.
Adams said that SAMWUMED has not shared a clear rationale for the decision.
She said that SAMWUMED patients specifically select Melomed Hospitals due to their locations in the Cape Flats and the fact that their specialists overwhelmingly charge contracted rates, meaning little to no “out-of-pocket” expenses are felt by SAMWUMED patients.
“By excluding us, SAMWUMED is stripping members of their preference and access to a healthcare provider deeply integrated into their communities who understand the socio-economic circumstances of persons residing in and around the Cape Flats,” Adams said.
“This decision blatantly ignores the socio-economic realities of SAMWUMED members who reside in the Cape Flats,” she said.
“Directing patients to hospitals outside these areas creates significant challenges, including added travel time, transportation costs and inconvenience during emergencies or regular healthcare visits”.
A lack of communication
Adams berated SAMWUMED and noted that the union has also failed to communicate its decision to members adequately.
“SAMWUMED members have not been officially informed of this change, and their website, communications, and benefit brochures remain outdated and still include Melomed hospitals on the lists,” she explained.
“This lack of transparency compounds the confusion and disruption for members. This move not only erodes access but also disadvantages the very municipal workers SAMWUMED claims to serve. It is directly counter to ensuring equitable healthcare access.”
Despite the actions by SAMWUMED, Adams said that Melomed is still willing to deal with the union.
“We are open to finding a solution that puts the best interests of SAMWUMED members back at the centre of decision-making,” she added.
Could not reach an agreement
SAMWUMED confirmed to IOL that it was changing its hospital network in 2025 following the formal termination of its agreement with the National Hospital Network (NHN), which includes the Melomed Group.
SAMWUMED said its agreement with the NHN, which commenced in January 2021, had now expired.
Francina Mosoeu, SAMWUMED's Principal Officer said the union could not reach a mutual agreement with the NHN and as a result reached out to the Melomed Group to allow their facilities most frequented by members as "filler hospitals" in the union's network but again could not reach an agreement.
"It should be made clear that neither the NHN Group nor the Melomed Group were prepared to come to a mutual agreement with SAMWUMED and that SAMWUMED exhausted all avenues to come to a mutual agreement with Melomed and NHN," she said.
The union said that a new hospital network has been put in place and will take effect from January 1, 2025.
"The scheme is initiating a communication drive to inform our members of the transition to the new arrangement to avoid copayments in 2025."
Mosoeu said that members who had previously made use of the Melomed facilities would now have access to the new hospital network.
An Illogical decision
The NHN has criticised the development between SAMWUMED and Melomed Hospitals.
“Given the latest development, SAMWUMED cannot deny that the decision to terminate the agreement will adversely impact its members and beneficiaries who enjoyed low fees in Melomed facilities and other NHN member Hospitals such as Rondebosch Medical Centre,” Loedt Zemanay Group Operations Manager for the NHN said.
“The decision to terminate is shocking, illogical and highly questionable as its impact directly affects the livelihood of patients,” he added.
Zemanay said that the Melomed tariffs are by far amongst the lowest in the market for the union.
“it is even comparable with the largest medical schemes which because of their sheer size command lower prices. This has been validated by independent actuaries,” he added.
He said that most Melomed doctors have established relationships with their patients and that this will be abruptly severed due to the decision by the union.
Moreover, SAMWUMED members will now be exposed to huge co-payments, he emphasised.
Zemanay said that Melomed employed more than 5,000 staff, mainly from the Cape Flats, and they will be negatively affected by this new development.
"The decision by the SAMWUMED’s leadership flies in the face of low tariffs, accessibility, economic transformation and job creation on the Cape Flats,” he exclaimed.
IOL BUSINESS