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Category:
Insurance
News /
Medical Schemes /
Discovery Health
/ July 2006
Discovery Health to fund revolutionary new
cancer scan
The Discovery Health Medical Scheme, South
Africa’s largest medical aid scheme that covers close on two
million lives will, from the 1st of August 2006, fund PET
scans for certain oncology patients through an initial pilot
project.
PET scan (Positron Emission Tomography) is a
non invasive diagnostic imaging procedure that allows the
study of body function so it can help physicians detect
alterations in biochemical processes that suggest disease.
This technique uses special computerised
imaging equipment to capture images of the body’s function
and reveals information of health and disease - particularly
certain cancers. It can more accurately assess staging of
tumors and has the potential to monitor the patient’s
response to therapy.
 Discovery
Health’s Dr Jonathan Broomberg, Head of Strategy and Health
Policy says, “A PET scan is like no other imaging technique
as it shows the internal chemistry of the body and hence
gives more comprehensive picture of certain diseases than
other current diagnostic radiology scans .
The PET scan monitors metabolic or
biochemical activities in the body by tracking the movement
and concentration of a radioactive tracer (isotope) injected
into the blood stream.
“Another advantage is that because the
radioactivity is very short-lived, patients’ radiation
exposure is low. The substance amount is so small that it
does not affect the normal processes of the body.”
Broomberg says that Discovery believes in
giving its members access to the latest innovations that are
clinically appropriate, have undergone vigorous testing and
are supported by strong global evidence of their efficacy,
and cost effectiveness.
“Whenever new technologies are introduced
into the environment, we undertake rigorous clinical and
financial evaluations prior to agreeing to fund these. This
is consistent with international best practice, and is
critical to the ongoing affordability and sustainability of
South Africa’s medical scheme environment.
“As part of this evaluation process, it is
always our policy to work very closely with SA’s medical
practitioners. In this case, we have been working
intensively with the Radiology Society of South Africa (RSSA)
and the South African Oncology Consortium (SAOC) on a
process that would ensure that PET scans would be used for
the appropriate patients, and in identified centres with the
appropriate expertise. As a result of these discussions, we
have agreed that we will run a pilot with a group of
radiology practices for a specified group of oncology
conditions, where the benefit of PET scans is clearly
demonstrated.
“This was decided as PET scans remain a new
and revolutionary technology where there is still
unfortunately limited documentation on the
cost-effectiveness and outcomes.
“By implementing a pilot we will work with
the Radiology Society of South Africa and the South African
Oncology Consortium (SAOC) to ensure appropriate clinical
indications and funding to make certain it does not
unreasonably add to the contribution costs of all our
members.”
The pilot will run for a 12-month period from
1 August 2006 to 1 August 2007. If this proves successful,
this approach may be expanded beyond the current radiology
practices.
Broomberg says for a patient to receive a PET
scan, the requesting oncologist will need to complete a PET
Scan Requisition Form.
“The requisition will be reviewed by an
independent panel of oncologists and radiologists, outside
of Discovery. If the panel indicates that it is clinically
appropriate, Discovery will fully fund the PET scan from the
oncology benefit, and the oncology service specialist will
advise the radiology practice of the authorisation. If
however the panel does not approve the scan, Discovery will
abide by this recommendation and the scan will not be
funded.”
Source: ITInews – Insurance
Times and Investments Online
www.itinews.co.za
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