4 May 2021
The Role of Medical Aids in Prevention and Treatment of Substance Use Disorders
Medical aid benefits are often only provided for patients who qualify for institutionalisation, which means it’s impossible to know how big the problem of Substance Use Disorders is, says Johann Van Zyl, ADDICTION 2021 Conference EXCO member.
“Substance dependency often presents as an underlying or associated mental health or psychiatric condition and remains unreported. This, combined with the stigma attached to receiving treatment for drug abuse, means that patients who aren’t institutionalised aren’t reported on,” says van Zyl.
How medical aids can educate and identify at-risk members
There are a variety of approaches that medical aids should consider to educate their members and the general public on Substance Use Disorders, including identifying patients that are at risk during wellness days or other health risks screening programs so that early intervention can take place; identifying at-risk patients by analysing claims data, as patients that have early Substance Use Disorder often demonstrate specific health-seeking and claims behaviours; and providing educational material through outbound messaging.
“I’m not aware of any specific educational programs on substance abuse that are presented by medical aids currently. At best, medical aids occasionally run articles in the funds' newsletters. Medical aids are well-positioned to assist with educating people on Substance Use Disorders, by developing methods to identifying at-risk patients, and intervening early.
Medical aids must also to recognise that Substance Use Disorder is a chronic illness in its own right and that it will unlikely be resolved sustainably through a conventional 21-day in-patient program as is prescribed by the Regulations to the Medical Schemes Act. The only true indicator of program effectiveness is long-term sobriety.
These patients require long-term maintenance treatment and support in addition to the minimum benefits prescribed in the legislation. Failing this there will always be the risk of relapse and repeated admissions” says van Zyl.
Substance Use Disorder is a chronic illness and should be treated as such.
To better assist members in combating Substance Use Disorders, medical aids need to acknowledge that the disorder is often complex and requires a multi-disciplinary approach.
Van Zyl says patients do not necessarily relapse due to a deliberate lack of compliance. Patients with Substance Use Disorder often present with unrelated physical or mental health conditions. Suboptimal treatment of Substance Use Disorders could lead to associated, or so-called downstream, healthcare costs which could have been avoided if the Substance Use Disorders were appropriately managed in the first place.
“Recognising Substance Use Disorder as a chronic illness and aligning medical aid benefits accordingly will aid with earlier diagnoses and interventions, with better associated clinical outcomes that can be measured by long-term sobriety.
Medical aids must shift from the emphasis of a benefits-based approach of a three-day detox and 21-day treatment plan to a patient-oriented approach whereby benefits are more individualized in relation to associated medical conditions and the types of dependencies. Long-term sobriety will help more people return to economic activity and have a positive impact on members’ health and lives,” concludes van Zyl.
The Annual Addiction Conference will be held virtually this year, and it will take place on 21-23 July 2021. Practical, evidence-based Substance Use Disorder solutions relevant to the unique African context will be discussed alongside doctors, social work specialists, rehabilitation providers, researchers, and pharmaceutical manufacturers.
ENDS
MEDIA CONTACT: Rosa-Mari Le Roux, +27 60 995 6277, rosa-mari@thatpoint.co.za, www.atthatpoint.co.za
For more information on the ADDICTION 2021 Conference:
Website: www.addiction.org.za
LinkedIn: https://www.linkedin.com/events/6764476872391712768/