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Coronavirus | How SA medical aids and hospital groups will pitch in

Mar 19 2020 12:59 

Londiwe Buthelezi

Big private hospital groups have commited to offer support to government.

As the number of confirmed coronavirus cases rises every day in South Africa, and the likelihood of more internal transmissions escalates, many people are starting to wonder whether they’ll get adequate medical attention should they be diagnosed, what their medical schemes would cover them for, and what will happen to those without health insurance as state hospitals are already in a state of dysfunction.

Fin24 asked medical schemes and private hospital groups what they are doing to cooperate with government in terms of covering testing and treatment and providing quarantine facilities, if the load of people requiring hospitalisation gets to a point where beds in the military hospitals aren’t enough to accommodate all those who need admission.

How medical schemes will cover coronavirus

Fin24 asked the country’s three biggest open schemes how they will cover testing and treatment.

The country’s biggest open medical aid, Discovery Health Medical Scheme (DHMS), in line with many other medical schemes, has created a new benefit package to cover DHMS members diagnosed with the coronavirus, called the WHO Global Outbreak benefit. It covers all members on all plans where infections occur within South Africa, giving them access to diagnostic testing for both the coronavirus and influenza.

Members who test positive will get their consultations and treatments covered from the scheme’s risk pool as opposed to their day-to-day benefits and savings. But for those who don’t have the virus, their diagnostic tests will be covered from day-to-day benefits. Infections that occurred while members were travelling abroad will be covered by the DHMS International Travel Benefit.

“It is very important that Covid-19 testing is only done for appropriate people, who are high risk and meet the Covid-19 case definition. Testing of asymptomatic people, who are low risk and potentially being tested to allay anxiety, will overwhelm the healthcare system,” said Discovery Health CEO Dr Ryan Noach.

Bonitas Medical Fund will cover diagnosis, treatment and care for the coronavirus from the risk pool as well. Members who meet the criteria of being “a person under investigation by the NICD [National Institute for Communicable Diseases]” qualify for these test benefits. Treatment protocol for members who test positive will be in line with the WHO Global Outbreak Benefits.

“The test to confirm the diagnosis is covered from risk pool, not member benefits. If it’s pneumonia or respiratory failure, this is covered by prescribed minimum benefits,” said Lee Callakoppen, principal officer of Bonitas Medical Fund.

Momentum Medical Scheme said it will cover the cost of diagnostic tests and treatment and hospitalisation, where necessary, for all members from its risk benefits. 

Hospitalising people with no medical aid

According to the projections prepared by the South African Centre for Epidemiological Modelling and Analysis, around 80% of cases will be “mild”, while 15% to 20% of those infected may develop pneumonia and may require hospital admission. With public hospitals in South Africa already struggling to cope with serving the 80% of the population that depends on the state for care, commentators have expressed skeptism on whether South Africa would be able to house those who need hospitalisation.

On Wednesday, the Economic Freedom Fighters leader Julius Malema said private hospitals risked nationalisation if they failed to cooperate with government. He also called on businesses producing hygiene cleaners and products associated with the coronavirus not to try and maximise profits.

“The only way to avoid nationalisation of those private hospitals is by fully cooperating with the minister of health when he needs beds for our sick people,” he told media at a briefing in Cape Town.

RH Bophelo, a JSE-listed group that has eight hospitals, said it had offered the department of health a full isolation facility at a “huge discount”, should government run out of capacity.