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Medscheme ready to deal with deluge of COVID-19 admissions

20 July 2020 Medscheme

As the number of confirmed coronavirus cases rises every day in South Africa, Medscheme – the largest health risk management services provider - has assured members of the schemes that it administers, that it is collaborating with all private hospital groups to make sure that those positively diagnosed with Covid-19 will get adequate medical attention and their hospitalisation will be covered. At the moment there is sufficient capacity.

“The COVID-19 pandemic is highlighting the need for healthcare organisations to daily evaluate and adapt their care delivery models. We are assessing the impact of this virus on overall claims, private hospitalisation and access to private healthcare providers on a daily basis,” said Dr Lungi Nyathi, Medscheme’s Managing Executive: Clinical Risk and Advisory.

Medscheme looks after 3,5-million lives through administering 20 medical schemes including Bonitas, Fedhealth, GEMS, Polmed, Nedgroup, Sasolmed and 15 others. At least 12% of COVID-19 tests conducted in the country are done for these schemes.

“If and when a large influx of patients, unsure of their COVID-19 status, arrive in person to private healthcare providers seeking consultation or treatment, we are working with these healthcare providers to address the demand, capacity and potential backlog for services, as well as other issues. Taking into account the infection rates, severity levels, treatment costs and admission levels, we can safely say all our members are being accommodated and taken care of,” Dr Nyathi said.

“We want to assure members of the schemes that we administer that we have got you covered,” she said.
“There are approximately 25 800 adult acute beds in the private sector and about 3 700 day hospital and subacute hospital beds that we can send stable patients to. In addition, there are 3
600 dedicated paediatric beds nationally. We are seeing private hospital admissions of about 400-500 per week so far, plus a reduction in non-COVID admissions, so the hospital bed capacity status is dynamic,” said Dr Nyathi.

“Over the past weeks we have implemented mechanisms for tracking private bed capacity for our members. We have implemented tariff structures to ensure that the subacute and day hospitals can accommodate appropriate admissions where provincial license exemptions have been granted when the time comes. We have laid the rail tracks so that they are ready for when the train needs to pass through,” she said.

Medscheme has set up helplines since lockdown to assist its schemes’ members to get accurate and up-to-date information around COVID-19 and the availability of private beds and facilities. For those members who are in scheme options with private hospital networks, some of the schemes have lifted the non-network copayment rules where there are capacity constraints to make it easier for them to get access to care when they need it.

Medscheme is working with all private hospital groups, Mediclinic, Life Healthcare, Netcare, NHN, Clinix and JMH to facilitate the admission and treatment of patients.

“Our schemes have paid R111-million for COVID-19 pathology tests and over R150-millon for COVID-19 private hospitalisation as at 13 July 2020. Whilst it is evident that COVID-19 is going to be with us for a while, we will continue engaging with our various stakeholders to make sure we enhance the quality of life of our members and society in general,” said Dr Nyathi.

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