Medical aids in South Africa won’t have to cover gaming addiction

Medical aids in South Africa will not have to provide cover for “gaming disorder” when the World Health Organisation (WHO) releases its latest International Classification of Diseases (ICD), the Council for Medical Schemes (CMS) in South Africa told MyBroadband.

The WHO recently included gaming disorder in the latest draft of the ICD, but this won’t be implemented in South Africa for several years.

Even after it is implemented, though, medical schemes in South Africa wouldn’t be required to cover treatment for gaming addiction under the current regime of legislation.

“Most medical schemes are currently only funding mental health conditions that are included in the Prescribed Minimum Benefit regulations,” CMS clinical unit senior manager Dr Olurotimi Modupe, told MyBroadband.

“Habit and impulse disorders are not included, and as such will not be funded by medical schemes.”

Big changes discussed

Modupe added, however, that it is important to note there have been legislative changes which may affect how conditions are covered in future.

“A Comprehensive Service Package has been proposed in the Medical Schemes Amendment Bill that was released for public comments recently.”

South Africa is also gearing towards a universal health coverage system. This is to ensure access to quality health care for citizens, irrespective of socio-economic status.

“This may affect how services are purchased, offered, and funded,” said Modupe.

For this reason, the CMS can’t predict whether or how gaming disorder may be covered in future.

When ICD–11 will be implemented

Modupe explained that the draft ICD which lists “gaming disorder” is the eleventh revision of the document.

While the ICD–11 mortality and morbidity statistics coding system was launched on 18 June 2018, it will only be implemented in South Africa on 1 January 2022. Until then, South Africa will continue to use ICD–10.

“It is important to remember that the ICD–10 and ICD–11 are both an International Statistical Classification of Diseases and Related Health Problems. As such, each diagnosis and disease may not have its own code,” said Modupe.

“Although the current ICD–10 coding list does not have a specific code for gaming disorders, it can still be coded.”

Gaming addition is classified as a habit and impulse disorder, and therefore has the following ICD10 codes:

  • F63.8 Other habit and impulse disorders.
  • F63.9 Habit and impulse disorder, unspecified.

What medical aids will pay for

“In terms of funding obligations, medical schemes are expected to fund evidence-based, cost-effective, and affordable health care,” said Modupe.

“Health care decisions require considerations of costs and benefits, economic evaluation is essential for this purpose. Therefore, funding for the diagnosis, treatment, and care of the condition will have to be in line with these principles.”

Modupe explained that medical schemes do not have to fund all conditions, diseases, and disorders, but must state in their rules what the minimum benefits are.

Where to get treatment

Regarding treatment for addiction to gaming, Modupe said the health care practitioners who make the diagnosis should be able to refer patients to the relevant centres for rehabilitation.

“A multidisciplinary team approach is usually recommended to manage mental health disorders,” said Modupe.

“All psychiatrists and clinical psychologists will be able to treat gaming addiction, as the same principles and treatment protocols as for other addictions apply.”

All registered mental health facilities will also be able to admit patients on a voluntary basis.

“Unfortunately, few mental health facilities currently have involuntary beds available. Involuntary treatment for addiction or habit and impulse disorders are also not very successful,” said Modupe.

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Medical aids in South Africa won’t have to cover gaming addiction