Home » Hanafi Fiqh » Askimam.org » I am a Muslim doctor who is constantly asked about health care and the fees related thereto. Often I am

I am a Muslim doctor who is constantly asked about health care and the fees related thereto. Often I am

Answered as per Hanafi Fiqh by Askimam.org

I had the pleasure of attending my second Shariah compliant business campaign on Sunday 28/08/2005 in Camperdown.

Many important issues were highlighted. Shukran to you and the ulema for the guidance. May ALLAH continue continue to guide people like you so that people like me can be further guided and may HE give us all the ability to practice like true muslims should

Many issues were clarified for me. However, upon further introspection many more questions have been
raised for me, and I need help in further understanding these concepts and direction. One of these issues pertains to Medical Aids (MA). (Please pardon the lengthy explanation that follows)

I am a Muslim doctor who is constantly asked about health care and the fees related thereto. Often I am
asked which is the “best Medical aid” to take out. I have been advising member and non-members of my family w.r.t. this issue. But yesterday, you mentioned that Medical aids and hospital plans are not permissible.

I had enquired on at least 2 occasions (most recently last Ramadhaan from an established organisation in Durban) of the permissibility of MA. I was told that they may be considered permissible (Please do not be offended – I am not doubting the validity of your ruling – I just need understanding of the concept for future reference, so that I may also guide people in future.)

I find myself in a very unique position –  1. I am a doctor in both the private and public sector 2. I am both a doctor and have been a patient (and have immediate family who are patients) in both the
private and public sector 3. I do both emergency work and deal with non urgentmedical work as well
4. I DO HAVE A MEDICAL AID and have used it – some of my income comes by way of payments FROM patients medical aids

As you can see my situation is somewhat complicated…!! But let me explain further my understanding, then perhaps you can correct any pitfalls

Medical aids differ from Medical insurance.

Medical Insurance allows an individual to claim from the scheme/fund in the event of eg.disability. One
does this by way of contributions to the fund. In the event one in unable to work / or be gainfully employed
either temporarily or permanently, the fund will pay either a monthly “salary” or a one off lump sum to the
client / individual(depending on the contributions the individual was making). This money can be used as the patient sees fit (everyday living, etc.) No further effort is required to “earn an income”. One example of this may be the Govt’s disability pension scheme.

 Another is the Professional provident society, which pays a salary to the professional as long as he is out of work for illness. Medical insurance –to me – is not permissible since an element of risk is involved and one is guaranteed of an income / risq even tho’ a calamity / test may be put forward by ALLAH.  I see this in the same light as Life insurance / life Assurance. One cannot earn / benefit from the loss on an indiviual

Medical Aid on the other hand requires the payment of contributions to a scheme which then then offers to pay out service providers on the clients behalf for medical care provided. My understanding is that no
component of my contribution is paid in interest. The services provided are not necessarily going to remove the calamity that has been placed before you. It however, provides ACCESS to medical
care that would otherwise be unaffordable to (even some of the MOST wealthy) people.  (see 3 below).
Whilst there is an element of uncertainty w.r.t. future health, one also needs to consider the following:

1. The public health sector in this country is over burdened with scant resources. Many limitations are
placed on sometimes simple medications that have now become unaffordable to the state – by the states own admission . The MA provides another avenue for the acquisition of necessary care by only providing access to it – care that may otherwise be denied in a state hospital. Eg. Kidney transplant / failure patients over a certain age may be denied dialysis because they are past a certain age-cutoff. Without MA, additional Zulm is placed on the patient by their deterioration and suffering – something that could be avoided if the patient had a medical aid. Whilst spiritual trust in ALLAH to provide cure is always needed, I don’t think Islam encourages one NOT to seek appropriate medical help. I have had patients with a heart attack that were denied care in a pubic hospital because “there are no beds in ICU”.

 2.A patient in the private sector NOT on medical aid – usually has to pay cash deposits up front upon
admission, sometimes as much as R20 000 – R 30 000 to the private hospital. Even if one has the financial resources available, usually they are tied up in a bank account that is not accessible after hours. Too much time is wasted unfortunately in bureaucracy and red tape trying to get treatment for the patient. Had I not had a medical aid I would have been in this very situation this year over the Easter long week-end when my wife had to undergo emergency surgery. My next option would have been the public sector, not knowing when my wife was even going to be assessed! She would have suffered in the meanwhile…   

 3.Healthcare in this country in particular is exorbitant (being on both sides of the fence – I know) Sometimes, costs for a privately paying patient can run up > R100 000 in 1-2 days eg. Accidents / heart bypass in an ICU. I know of people who have had to bond the houses / assets or take out interest bearing loans just to pay for medical expenses.   

 4.I view MA as a case of “tie your camel, then place your trust in ALLAH (SWT)”. I am allowing myself
access (no guarantee) to the health care. Wearing a seatbelt when u drive is permissible.

 5.With asset insurance, the asset can be replaced – health related issues cannot be viewed in the same light.

6.One may say “what if you don’t ever have need to use the available facility – then you have lost all
your contributions – a case of take a chance and lose”. Where does vehicle tracking (eg NetStar) and armed response security companies subscriptions fall w.r.t. permissibility?

 7.I don’t see the element of risk and gambling in it. In fact, I see it as taking the necessary precautions
eg, like locking my house door and then reading ayaatul kursi or building a verandah and putting a railing on the edge to prevent my child from falling off

 8.I view MA as “membership” to a “club” of health service providers that allows me access to their
facilities when I need them – but no guarantee that the facilities are going to cure my problem.

 9.MA’s do not provide income whilst one may be ill. They allow you care to be able to get well again so
that you may one again become a productive member of the muslim community

 10. Admittedly, most medical schemes / aids are administered by companies that are in the actuary industry and that they are involved in non-permissible products eg. life insurance. Legislation is now coming into effect requiring medical aids to be non-profit and independantly functioning schemes (or so i’ve heard)

 11. Where does claiming from the Road accident fund fit into the picture??

 12. What about professional insurance for eg. doctors come in eg. medical protection society, medical defence union – Most employers wont even employ you without these and with the rate of litigation (usually solely for the monetary benefir fro the plaintiff) – trying to practise without this is tantamount to professioanal “suicide”

Please pardon me if my arguments come from a standpoint of ignorance – I write to you and the ulema
for guidance. In addition, as an employee of the state, part of my benefits are that the state allows me (not compulsory) to take out a medical aid of my choice (2/3 paid by State and 1/3 by me). This is part of my employment benefits – should I chose not to use this option, I do not get any other monetary compensation for not using this option. Effectively, I don’t take all benefits that my employer is offering to me. One also needs to consider that we work all around the Durban area without getting a travel allowance!

 Having said that, a new Medical scheme has bee regisitered recently GEMS – Govt employees Medical scheme. There has been a more to ensure that ALL Govt employees (by as early as next year) be “attached” to a medical scheme. GEMS has been introduced as one of the cheaper options, thus allowing all govt employees to have membership. In future it is envisgaed that ALL govt employees be attached to GEMS – subsidising other medical schemes  for govt employees  will then not be allowed. This is supposed to be similar to the current GEPF – govt employees pension fund.

Please see ffg insert in South African medical association newsletter “Medigram 26/08/2005”: 

Labour Talk: Public servants give input on government medical scheme


 Public sector labour unions will submit their proposals for amendments to the new Government Employees Medical Scheme (GEMS) to the Public Sector Co-ordinating Bargaining Council (PSCBC) by September 1. GEMS was registered as a medical scheme for public sector employees with the Council for Medical Schemes (CMS) in January this year. Plans are to phase in mandatory enrolment of GEMS for all public sector employees over the next two years. The objectives of this scheme include:

  • extending medical scheme coverage to those currently without cover;
  • ensuring equitable access to a reasonable set of benefits; and
  • allowing members the ability to purchase additional benefits as their affordability permits.

Labour organisations have raised concerns about, among others, the available options, contribution level and the capping of subsidies. They also want labour representatives on the GEMS Board of Trustees, and wish to participate in benefit design. Enquiries: labour@samedical.org or 012 481-2096.

Where does this leave me??

I am really confused  !!! but want clarity on two questions:
1. Are Medical Aids permissible?? If not, please try to make me understand why so that I may advise other people appropriately
2. Is my situation w.r.t my Medical aid via the state subsidy any different?? Please explain

Please forgive me again, but I seek guidance…

“Ya fataho, Ya Aleem, Ya Razako Ya Kareem. Ifta Ilayna
bil Quraanil azaaem”

 ps.Perhaps, a talk / discussion by the ulema at our medical school to (at least ) the muslim students and doctors will help us all to clear the air

Answer

We have been encouraged by your participation in our Shariah Compliant Business Campaign. JazakAllah for your kind words and duas. Make dua that Allah grant us Ikhlas and most importantly His pleasure. (Ameen). I apologize for the much belated response. I have carried your e-mail with me while traveling to the I am now crossing the Atlantic Ocean and took the good opportunity to read your lengthy email and reflect upon its contents. I summarize your concerns in four points:

flexibility in this situation. I will be happy to set up a meeting with doctors and professionals to discuss this issue. You may contact me through e-mail now or personally after Ramadhan.

Jazak Allah

And Allah Ta’ala Knows Best

1) Difference between medical insurance and medical aid

2) Road Accident Fund

3) Professional Insurance

4) Government Medical Aid Scheme

I fully agree for the need of a Shariah Compliant Medical Aid Scheme based on the points raised by you. This has been the first issue under discussion by the Jameeatul Mufteen, a national body of Muftis comprising of 12 Darul Iftas. I have arranged for a meeting after Ramadhan between the Darul Ifta and some CEO’s of insurance companies to deliberate on a Shariah Compliant Medical Aid Scheme. Make dua that Allah guides us. Ameen.

There is a difference between medical insurance and medical aid in that medical insurance offers aid to the client directly and medical aid offers aid through its agents. However, this difference is not significant and will not have a bearing on the ruling in Shariah. Both medical insurance and medical aid are however common in seeking financial gain/loss based on a future uncertain event. Both, the company and the client either gain or lose. If a client makes a contribution and nothing happens, the company benefits and if something does happen and the company pays out more then the client’s contribution, then the client benefits and the company loses. This is also found in a life insurance cover and therefore not permissible.

The Road Accident Fund also falls in the same category. It is a contribution to a future uncertain event. However, as an alternative, if the fund offers some material service, the contribution could be in lieu of that and it would then be permissible to contract such a Road Accident Fund. If a car tracker company provides material service, for example, it monitors the movement of the car through its system, then that is permissible. House alarm and securities also fall in this category. A Shariah Compliant Medical Aid could also be devised based on this principle.

The issue of Professional Insurance has to be viewed in conjunction with the GEMS (Government Employment Medical Aid Scheme). It is important for the Darul Ifta to understand this new initiative by the Government and consider the Shariah ruling based on that. This new initiative would have major bearings in Shariah if it is purely a Government Scheme and not a private scheme. There will be more Mufti Ebrahim Desai

 

and Allah Ta’ala Knows Best

 

Mufti Ebrahim Desai

Your lengthy email refers.

Unfortunately, for reasons unknown, I only received a copy of your email a few days ago, hence the delay in replying.

We appreciate your kind Duas, and highlighting important issues around medical aid. However, while you are most welcome to detail the dilemmas around the issue, it should not be presented in a way as to influence or lead a particular answer that you seek.

For a long time now we have been very much concerned about the issue of medical aid. In this respect we are working towards finding an alternative, like we have done in the case of vehicle financing. Unfortunately our work is disrupted during Ramadhaan. We have a meeting planned with senior members of Discovery Health after Ramadhaan, where will explore the possibilities of a Shari’ah acceptable alternative scheme. Make Dua Allah Ta’ala guides us in this matter, and we are able to find a workable solution.

On the issue of you receiving income from medical aid companies, the position is that it would be permissible for you to receive payment from these companies. Your actual client is your patient, who even in legal terms is liable to you. Thereafter the patient makes arrangement for his/her medical aid company to pay you on their behalf. You are not responsible for the relationship between the patient and the company. That is their private matter. Hence it is permissible for you to receive payment from the company.

From your email we understand that you share a common misunderstanding regarding insurance and similar transactions. Insurance is not Haraam based on the factor that one is placing one’s trust on the company. Similarly it is not Haraam based solely on the fact that you are getting cash or an income. To understand the basis for it being Haraam, one has to understand the definition of Qimaar (gambling) in the Shari’ah. To suspend provision of an entity on an uncertain future event is termed Qimaar. Hence in insurance, the payout is suspended on an uncertain event, for example an accident or death. This incident may or may not occur during the subsistence of the contract. Similarly, in the case of Medical Aid, the service of the doctor or hospital is suspended on the uncertain event of the patient requiring the service, which may or may not arise. This uncertainty is termed “gharar” in the Shari’ah, and renders the contract invalid and void.

If similar aims could be achieved via a contract that is acceptable in the Shari’ah, then it would not be contrary to tawakkul (trust) to make arrangements for such contingences. It would be perfectly permissible if it were conducted via a contract or arrangement that conforms to the Islamic Law of contracts.

In the Shari’ah, one does not have a legal right to claim from the Road Accident Fund. Any payment from them would only be acceptable if it is a voluntary offering from them. If they refuse, one cannot claim.

Medical Insurance is unacceptable in the Shari’ah.

As far as voluntary schemes are concerned, one may not be part of those scheme, even though in the process one may loose the benefits offered by one’s employer.

On the other hand in the case of compulsory membership, which is paid for by one’s employer, one may accept the services offered, however, one does not have a legal right thereto (in terms of Shari’ah).

We trust we have covered the points of your email.

We appreciate you input, and are ourselves concerned about this matter. Do make Dua that we are able to find a solution.

And Allah Ta’ala knows best.

Jazakallah and Was Salaam

E. Vawda
for Daarul Iftaa

Original Source Link

This answer was collected from Askimam.org, which is operated under the supervision of Mufti Ebrahim Desai from South Africa.

Read answers with similar topics: