The Council for Medical Schemes (CMS) regulates 80 medical aids in a R160bn industry, but don't expect a speedy, clear or consistent response when challenging a medical aid for life-saving treatment. The "regulator" has been "derelict" in its duties, said Wits School of Governance adjunct professor of governance Alex van den Heever, speaking about a case in which it has failed to enforce a ruling made against the Government Employees Medical Scheme (Gems) to provide a life-saving treatment. The urgent case for the patient with a rare condition called Gaucher disease, which requires medicine costing more than R3m a year to treat, has been at the CMS for more than a year and remains unresolved. The patient is getting sicker, her doctor has testified. The patient won her case at the CMS in March last year, and won an appeal in October when the council ruled that medicine must be provided because it is life-saving. But the council is not enforcing its appeal board ruling that Gems must ...

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