Picture: 123RF/LANGSTRUP
Picture: 123RF/LANGSTRUP

In a rare show of unity, doctors’ associations, economists, bankers and health activists have jointly devised a plan to save the private health-care sector, which is facing a significant financial threat as a result of Covid-19.

For the past three months, patients have stayed away from medical practices for fear of contracting the coronavirus. It has left private sector doctors unable to pay practice salaries, bills and debt on expensive imported equipment.

In the face of mounting financial woes, some have opted to take early retirement. Others, SA Medical Association spokesperson Dr Mark Human warned on Monday night, may look to emigrate rather than face bankruptcy here in SA.

It’s happening at a “crucial and critical time for the medical profession”, says Dr Richard Tuft, head of the Radiological Society of SA. “We need to have doctors prepared to work who have not gone abroad because they have gone bankrupt.”

According to health economist Alex van den Heever, Covid-19 has created an “anomaly” where, each month, medical aid members pay their monthly premiums, but these are accruing to medical aids rather than being paid out to doctors, due to low patient numbers. It is, he says, “destroying private medical practices in the country”.

Under the rescue plan, which Van den Heever helped design, medical aid administrators will pay doctors upfront, before they treat patients. This will mean they earn 70% of their takings per month in 2019, even if they treat fewer patients.

The plan is supposed to work as follows: if a doctor bills the three large medical aid administrators (Medscheme, MMI and Discovery Health) at only 50% of their 2019 payment levels due to fewer patients or cancelled surgeries, the medical aids will top up the shortfall to the 70% mark. If the figure exceeds 70% of the doctor’s 2019 monthly claims, some of that money will be kept back by the medical schemes to offset the advance payments.

At the same time, SA’s banks have been approached to provide low-cost debt to struggling medical professionals.

With their finances taken care of, doctors will be able to focus on treating Covid-19 patients, says Prof Glenda Gray, head of the SA Medical Research Council and a member of the Progressive Health Forum (PHF).

“This is not a bailout,” says Van den Heever. It is a “smoothing out” that will ensure doctors earn a base minimum salary to keep staff employed and practices running.

The catch is that if medical practices are busy next year, as people seek the medical care they deferred, doctors will not earn more than their 2019 monthly remuneration levels, no matter how many patients they treat.

The plan has been driven by the activist doctors of the PHF, led by former ANC stalwart Aslam Dasoo. The forum, in turn, has roped in multiple doctors’ societies to generate sufficient buy-in for the plan, says Van den Heever – if too few agree, it won’t work.

It would seem to be a necessary intervention, given that the government, without any consultation, has proposed paying doctors’ teams R2,498 per patient to treat Covid-19 patients. That won’t cover the costs of receptionists and other staff at medical practices, and debt on equipment. This way, they’ll be able to keep their practices afloat and concentrate on Covid-19 patients, says Van den Heever.

“If the private sector collapses, there will be no doctors to help the public sector’s response to Covid-19,” he warns.

Not that you’d think so, from the government’s response.

Grey says she’s heard stories of surgeons abroad who, unable to operate on nonemergency patients during the epidemic, are instead working as hospital nurses to support the Covid-19 response. In SA, however, medical professionals say their offers of support have been met with silence.

Dr Chris Archer is the CEO of the SA Private Practitioners Forum, which represents more than 3,000 specialists and some physiotherapists. He says: “Right from the beginning of the epidemic we wrote to the minister [of health] indicating our feeling that we needed the private sector to play our role in combating the epidemic.”

The forum, he says, never received a response

Dasoo tells a similar story about private doctors’ associations reaching out to the government. “None got a response,” he says. “We felt if we [the PHF] co-ordinated them, we could get a response.”

So far, the plan has been presented to medical aid administrators, including Discovery Health and Medscheme – but they have yet to come on board officially.

Dr Lungi Nyathi, managing executive for clinical risk and advisory at Medscheme, says the group is grateful to doctors for their “outstanding contribution”.

“Medscheme is having extensive engagements with the PHF and the various health-care provider societies about the challenges around Covid-19 and the sustainability of the health-care sector,” she says. She says they are determined to find a solution that keeps medical aids intact, helps doctors survive and improves the way the private sector is funded.

For now, though, Medscheme, is noncommittal, saying the plan will require regulatory approval.

Van den Heever, who once worked at the medical aid regulator, says the plan is designed in line with the law, so this is not likely the case.

The upfront payment plan, he says, amounts to a private contract between medical aid administrators and doctors, meaning it wouldn’t require government or regulatory approval.

However, the government’s seeming ambivalence to the plight of private sector health-care professionals has raised concerns that it doesn’t want the private health-care sector to survive, for the inexplicable reason that this will somehow allow National Health Insurance to flourish.

But if nothing is done to keep all SA’s doctors on board, Gauteng and KwaZulu-Natal will likely be even further overwhelmed by the expected influx of Covid patients in the weeks to come.

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