Attention deficit hyperactivity disorder: Insights into underfunding in the private healthcare sector in South Africa

Abstract

Background: Although the prevalence of attention deficit hyperactivity disorder (ADHD) has remained stable, the number of patients diagnosed with ADHD has increased in recent years owing to increased awareness. Despite this increase, medical schemes in South Africa have not improved their funding models for this condition.

Aim: The study aimed to provide an account of the funding that medical schemes provisioned for treating ADHD in South Africa during 2022.

Setting: All the South African medical schemes that were registered with the Council of Medical Schemes during 2022 (n = 72) and all their listed options were evaluated (n = 279).

Methods: The study analysed secondary data published on the medical schemes’ websites in the public domain. Statistical minimum, average, maximum and correlation analyses were performed using Excel version 16.58.

Results: Attention deficit hyperactivity disorder is not regarded as a prescribed minimum benefit (PMB) condition and therefore each medical scheme used its own approach to providing its beneficiaries with some or no benefits for ADHD. It was evident that ADHD was underfunded and lacked structured or standardised funding approaches.

Conclusion: Attention deficit hyperactivity disorder is underfunded in the private healthcare sector in South Africa. Better funding models are needed or ADHD needs to be registered as a PMB condition.

Contribution: Findings from this study highlight the urgency for structured and sufficient ADHD-specific funding by medical schemes. Considerations based on these findings may be applied in the National Health Insurance and in other countries around the world.