Cape Town - 101029 to 101030 - Dr Tom Croft and Vuyo Soldati assist a man who while drunk passed out and fell before defacating and urinating on himself while they were trying to suture his hand after being stabbed by his brother during a 12-hour night shift at Groote Schuur Hospital's trauma unit, ward C-14. The Trauma Unit and Resusscitation room were kept busy by a large number of patients from motor vehicle accidents and inter-personal incidents in which a large majority were cause by alcohol abuse. Photo: Matthew Jordaan

Cape Town - The next time you drink alcohol or use drugs and end up in a Western Cape provincial health facility as a result of injury or illness linked to an unhealthy lifestyle, be warned: you might end up footing your own bill irrespective of your economic status.

Western Cape Premier Helen Zille cautioned that the time of getting repetitive free health services could be over for those engaging in “irresponsible behaviour” such as excessive drinking and drug abuse, if the provincial government’s mooted policy became a reality.

But the SA Medical Association (Sama) and Democratic Nursing Organisation of SA (Denosa) have warned that such a move would only discriminate certain categories of patients and that it would trample on patients’ rights to confidentiality – a fundamental basis of medicine.

Such a policy, aimed at enhancing wellness and making people co-responsible for their health, is being explored by Health MEC Theuns Botha.

Speaking at the opening of a revamped paediatric ward in Victoria Hospital in Wynberg on Thursday, Zille said one option of deterring irresponsible behaviour was charging patients for care given instead of giving them free health care.

Zille spoke of her frustration with the burden of lifestyle diseases caused by such behaviour in the province. These included alcohol and drug abuse, sedentary lifestyles, smoking and unprotected sex.

She hinted that Botha was exploring an idea where patients who were considered “irresponsible” would be treated for free during their first visit, be given a warning the second time, and would be charged the full cost for their treatment if they were treated for a third time with the same problem.

Botha said if such a policy became a reality it would mean that patients would not be charged according to the “means test” as was the case currently, but according to their ability to be responsible towards their health.

“We are still investigating the measures of how to make people co-responsible for their health. We might have to adjust our policy of a means test. Even though people are poor and can’t pay for their health care, somehow they seem to afford paying for alcohol and drugs for instance… it doesn’t make sense. We have to stop the draining of our health care budget and save it for those with unavoidable diseases.”

Professor Sebastian van As, head of the trauma unit at Red Cross Children’s Hospital, said that although it was true that behavioural problems such as drinking had put a lot of strain on the health budget, “one has to be careful on how such a policy would be implemented”.

He said alcohol had been associated not only with violence and injuries, but with major infections such as HIV/Aids, TB, and also with adverse mental illness.

“So-called accidental injuries often can be prevented and are not inevitable, but one has to ensure that they don’t only single out alcohol and drugs. There are many factors which form part of this behaviour such as obesity and smoking and it would be tricky to determine which behaviour is irresponsible,” he said.

Dr Mark Sonderup, deputy chairperson of Sama, described the proposal as a populist statement, which had been made by other politicians in the world.

“Fortunately, all over the world such ideas have died the natural death they deserve because politicians aren’t doctors. Such an approach would be terrible not for only affected patients, but doctors involved. It is a judgmental approach that tramples on a fundamental basis of medicine – the doctor-patient relationship. What they are proposing would lead to a breakdown of that doctor-patient relationship, which should be confidential at all times. Doctors are not there to judge or penalise patients, but treat them. Such an approach would drive patients underground,” he said.

Bongani Lose, provincial spokesman for Denosa, said charging patients for treatment based on their behaviour was not only discriminatory, but it would have “devastating consequences as it would drive patients away”.

“Patients will no longer open up to health workers about their problems if they are going to be judged. So what good will this exercise do? The government should rather invest in interventions that address these social problems instead of penalising patients. It would be wrong to do that,” he said.

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Cape Argus