Picture: 123RF/ELLIOT BURLINGHAM
Picture: 123RF/ELLIOT BURLINGHAM

SA’s public and private healthcare sectors, and its medical schemes, responded to the Covid-19 pandemic quickly and well, with many lessons learnt that position the country well for an improved healthcare system across both sectors, and across multiple service providers.

However, there may be a couple of unpleasant surprises for medical aid members as far into the future as 2021.

The Council for Medical Schemes (CMS) took the quick and bold step of mandating all schemes to include treatment for Covid-19 as part of their prescribed minimum benefits, providing clarity to schemes and comfort and confidence to members that they would be taken care of should they fall ill. This is in sharp contrast to the business insurance sector, which has stalled on delivering on business continuity/interruption claims, due to obfuscation about whether the government or the pandemic caused the economic calamity arising out of the stricter lockdown levels.

This agility on the part of the CMS inspired confidence in the body, but also set the scene for other similar regulatory bodies in responding quickly to a particular situation — if one such body can do this, what is stopping other similar bodies from achieving this level of responsiveness?

Faced with the prospect of a virulent illness that spreads aggressively in person-to-person contexts, many medical professionals — particularly in private healthcare — quickly adapted to offer telemedicine consultations over WhatsApp, FaceTime, Zoom or Microsoft Teams. This has a number of advantages in addition to the obvious one of avoiding infection: it avoids waiting times; it enables quicker referrals to other specialists if required; and it eliminates transport time and costs.

Expanding the reach of telemedicine to the public healthcare sector, particularly for primary healthcare, will make a significant, positive difference to citizens who would otherwise have to travel for hours to a clinic, then wait even longer to see a clinician.

However, this is where there would have to be greater collaboration and co-operation across government departments and the private sector, as clinics would need to be appropriately equipped, and data costs would have to be affordable enough for people to access their healthcare providers remotely.

SA’s response to the Covid-19 pandemic has shown what can be achieved if public and private healthcare sectors collaborate effectively. It’s also highlighted new ways of consulting with primary healthcare providers

There was a significant amount of fear around Covid-19 — justifiably so — with people worried that they’d been exposed, scared when they’d been diagnosed, and even ashamed to discuss their status with family and friends. We set up a counselling service that our members and anyone else could call on for advice through their Covid-19 journey, whether it was to do an initial screening, discuss symptoms, or find out where the nearest testing station was located.

Similarly, this counselling facility — yet another example of telemedicine in action — could connect people with doctors to prescribe medication, in turn helping diagnosed people stay out of public places, but still able to access the medical help and supplies that they needed.

This counselling service was opened to all South Africans specifically to address Covid-19, but with its foundation being one of counselling, we noticed that callers shared information about other health and wellness concerns, including financial stress, domestic violence and substance abuse. Other issues raised included anxiety, bereavement, seeking work/life balance and general health and lifestyle queries.

Starting these conversations led to further counselling and action taken — as South Africans, we don’t talk enough and this platform got people open and talking more, addressing non-physical wounds and taking the first steps to addressing other issues that directly impact their health.

While this counselling service was specifically expanded for Covid-19, the stats it saw prove irrevocably that employee assistance programmes (EAP) or wellness programmes offer significant value. Once those stresses had been addressed and plans of action implemented, those struggling with issues besides the pandemic were empowered to enter the post-pandemic world stronger than before.

While SA was as high as fifth in the global infection rate at one point, the country’s mortality rate is very low, and the pandemic seems to be waning at a relatively quick rate. There were some lockdown regulations that were openly flouted with almost inspiring creativity, such as those around tobacco and alcohol sales, but the reasoning behind them was questionable and questioned.

Citizens’ compliance with mask-wearing and hand-washing, in particular, are likely to have contributed to the country’s success in managing the pandemic, and this was likely because of successful communication from medical schemes and from the government. We have never seen so much content from medical schemes created to educate the entire population and not just their members.

The department of health came out of the starting blocks strongly with its helpline, and continued to communicate frequently at predictable intervals, with data that could be trusted, and with storytelling that proved the link between masks and clean hands, and avoiding infection.

Given the risks of infection, many people have chosen to postpone essential but elective procedures, and the focus on hand-washing and mask-wearing has meant that the usual winter flu season — expensive for medical aids — has been virtually non-existent.

This means many medical aids now have surplus reserves, with those with a younger member base being buffered from the pandemic, which wrought the most damage among older members of the population.

Schemes with high reserves and younger profiles are stronger, while those with minimum reserves and older membership bases are more vulnerable — which means their premium increases are likely to be higher.

Having said that, our actuarial team predicts that medical schemes will implement an average 10.25% increase for 2021, with increases falling in a narrower-than-normal range of between 9.8% and 10.8%. While many have been insulated somewhat because of lower demand for non-Covid-19 care and procedures, patients that have deferred these this year are likely to have them done in 2021.

SA’s response to the Covid-19 pandemic has shown what can be achieved if public and private healthcare sectors collaborate effectively. It’s also highlighted new ways of consulting with primary healthcare providers that could make both sectors more time-efficient and cost-effective.

The truth remains that only 15% of South Africans can afford private healthcare, and then only with subsidies from their employers, and with membership contribution increases exceeding consumer price inflation every year, that number is likely to decrease. The private healthcare sector can also not afford for public health to fail as it simply doesn’t have the capacity to take on patient overflows in the long term, as it agreed to during the pandemic.

There’s no doubt that the pandemic is a horror of tragic proportions, but it has taught valuable lessons and accelerated innovation that could dramatically improve the lives of millions of people. We’re looking forward to seeing what the future holds for public, private, and universal healthcare models in SA.

• Ephraim is director of client value and risk at ASI Financial Services.

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