Tamar Kahn
4 September 2008
Cape Town — SA's private PET-CT scanning centres are struggling to recoup their multi-million-rand investments in state of the art cancer diagnosis equipment, warning that they will be forced to close shop by the middle of next year unless medical schemes relax their restrictions on patients' access to their services.
The scanners combine positron emission tomography (PET) with computed tomography (CT) to take sophisticated images of cancer tumours, providing more detail than other techniques such as magnetic resonance imaging (MRI).
PET-CT scanners are used only for cancers that have already been diagnosed from a tissue sample, or biopsy, and are used to determine how far the disease has advanced so doctors can select the most appropriate treatment for patients.
Six PET-CT centres were set up by consortiums of radiologists and nuclear medicine physicians in 2006, at an estimated startup cost of about R15m per centre. Two centres were established in Johannesburg, and one each in Pretoria, Bloemfontein, Cape Town and Durban. There are only two public-sector PET-CT scanners, at Pretoria Academic Hospital and Inkosi Albert Luthuli Central Hospital in Durban.
The Radiological Society of SA (RSSA) considered international experience and SA's cancer burden in the private sector to determine how many centres could be supported, said executive director Dr Bates Alheit.
Despite the proven benefits of PET-CT scanning, the centres were not getting enough patients to stay in the black, he said. The Cape PET-CT consortium's centre, for example, has the capacity to assess 120 patients a day, needs 70 to break even, yet is only getting 40.
It is consequently running at a loss of R250000 a month. A full-body scan costs between R14000 and R16000.
If the centres are forced to close, patients will have to use the scarce scanners in the public sector or go overseas for treatment, according to the RSSA.
The RSSA has laid the blame for the centres' low patient numbers squarely at the feet of medical schemes, saying Discovery Health in particular has put so many bureaucratic hurdles in the way of cancer patients and their doctors that it is putting them off.
Doctors and patients are anxious to begin treatment as soon as possible, and are turning to older techniques such as MRI and ordinary CT scans because schemes will usually authorise these scans within a day, according to an industry source .
Discovery patients frequently waited up to three weeks to hear whether the scheme would approve a PET-CT scan, he said.
Discovery's head of strategy, Jonathan Broomberg, denied such extensive delays, saying that the scheme processed authorisation requests "in one to four days".
Discovery had more than doubled the number of approvals for PET-CT scans over the past year, he said. The scheme paid for 244 scans in the first six months of this year, up from 111 in the corresponding period last year.
Schemes would not be pressured into funding unnecessary procedures, he said.
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