Be Alert: Overservicing in Hospitals Can Harm Your Health and Your Pocket

Receiving unnecessary medical treatment or procedures is a growing concern in South Africa's private healthcare sector. As a member of the UKZN Medical Scheme, it's important to understand how this practice can affect you.

What Is Overservicing?

Overservicing occurs when healthcare providers perform tests, procedures, or treatments that are not medically necessary. This can include:

• Being admitted to hospital when outpatient care would suffice.
• Staying in hospital longer than needed.
• Receiving higher levels of care than your condition requires.
• Undergoing excessive or expensive diagnostic tests.

According to the Health Professions Council of South Africa (HPCSA), overservicing is considered fraudulent and unethical. It can lead to physical and psychological harm, inflate medical costs, and drain scheme resources ultimately driving up your premiums.

Why Does It Happen?

Overservicing can occur for a variety of reasons, often rooted in how healthcare systems are structured. In many private healthcare settings, providers are reimbursed based on the number and type of services they deliver. This model can unintentionally encourage more treatment or longer hospital stays, even when simpler or shorter care might be sufficient.

Sometimes, providers may err on the side of caution, recommending additional tests or procedures to rule out unlikely conditions. While this can be well-intentioned, it may lead to unnecessary costs and interventions.

It's important to note that not all additional care is inappropriate, some cases genuinely require more attention. However, being informed and asking questions helps ensure that the care you receive is truly necessary and beneficial.

How It Affects You as a UKZN Medical Scheme Member

• Financial Impact: Unnecessary treatment increases claims, which can lead to higher premiums and reduced benefits.
• Health Risks: You may be exposed to unnecessary procedures, medications, or hospital environments that carry risks.
• Trust Issues: Overservicing erodes trust between patients and healthcare providers.

What You Can Do

1. Ask Questions: If you're recommended for hospital admission or a procedure, ask:
   • Is this medically necessary?
   • Are there alternatives?
   • What are the risks and benefits?
2. Know Your Benefits: Familiarise yourself with the Benefit Brochure to understand what's covered and what isn't.
3. Report Concerns: If you suspect overservicing, contact UKZN Medical Scheme at service@ukznms.co.za or call 0860 11 33 22.