Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

How private healthcare and medical aids are adapting for the ‘new normal’?

21 May 2020 Profmed
Craig Comrie, CEO at Profmed

Craig Comrie, CEO at Profmed

Profmed CEO Craig Comrie shares his thoughts on what a post-COVID world may look like

The world has changed beyond all our expectations. Due to the COVID-19 pandemic, industry, businesses and schools were closed for a government-mandated lockdown in South Africa that mirrored the example of more than half the world. Almost every industry has had to reimagine how it will work in a post-COVID world. One of the most directly affected areas is healthcare, which is having to adapt right now. How will the private healthcare sector define its ‘new normal’ and will we pay the price?

At private medical scheme Profmed, CEO Craig Comrie is used to imagining future scenarios. “The pandemic means that the physical working environment will change forever,” he predicts. “We will likely never go back to the same environments as before – the highly cramped open-plan office, for one, will have to change. And being digitally connected is going to be of prime importance.”

Comrie says the world will also become more aware of vulnerable people, in particular “the aged and those with chronic conditions that make them more vulnerable to viruses”.

Comrie believes attitudes towards hygiene, cleanliness and physical contact between people will change fundamentally, conceding that “perhaps when we have proper, proven vaccines over time attitudes may relax again.” It is a loss, in some ways: “Grandparents miss hugging children. We have taken the ability to do that for granted in the past and we have to be more careful in the future.”

Healthcare industry

In the meantime, the challenge to the healthcare industry as a whole is how to manage access to testing, particularly for vulnerable groups, to provide more regular testing, and to consider ways of keeping those at greatest risk, such as people over 60 and those with comorbidities, away from potential carriers.

Healthcare workers need additional protection. “Dentists, for instance, will need complete protective gear, and that comes at a significant cost, which could become added to members’ medical fund premiums. Hospital groups may want to do mandatory pre-admission COVID testing on patients – this too will add a cost.”

Comrie says that during April 2020, hospital admissions stood at half the number of April of the previous year. “People are trying to avoid going to hospital out of fear. Elective procedures are also not currently allowed, so are being delayed. But surgeries cannot be postponed indefinitely, so we anticipate that hospital admissions will rise again. But we will be reverting to a new norm. I anticipate doctor and nurse home visits will become fashionable again due to being safer than visiting doctors rooms or clinics”

Comrie says the world’s experience with HIV provides a useful analogy. “HIV changed how we managed healthcare and instituted new protocols. There is still no vaccine for HIV but awareness and testing makes things easier to manage and be more careful. COVID-19 will do the same. I believe the levels of awareness about how easily viruses are transmitted will never leave us.”

Medical funds

COVID-19 testing for everyone is expensive, and the question of whether medical schemes can afford to provide the tests to their members is pertinent. As Comrie explains, “If all 75 000 Profmed members were offered a COVID test in their benefits, it could add many millions that result in higher premiums. It would fast become unaffordable and threaten the 25% reserve that medical schemes are mandated to insure sustainability. We have seen the stock market collapse and so medical schemes’ investment income which subsidizes have also fallen through the floor. This will negatively also impact premiums into the future”

“At Profmed, we cover many individuals in private professional practices,” says Comrie. “Doctors, lawyers, engineers have not yet seen their industries return to normal. Our industries are all under stress in terms of being able to afford premiums for essential medical scheme cover.”

“Much is still uncertain and up in the air: How many COVID-related claims we will get is hard predict or project. Is the peak in September or November? What will the long-term impact of the pandemic be on our members? What do our members’ home and professional lives look like now; what can they afford. Overall it’s a difficult balance to find?”

“We are asking members to let us know upfront if they cannot pay their premiums. All medical schemes will have future scenarios with declining reserves due to estimated future claims and considered impact of the economic decline. Nevertheless, we are trying to support members on a case-by-case basis but we must protect all the members and the sustainability of the Scheme.”

Comrie says that in April 2020, for the first time Profmed saw more new members joining who did not have medical cover before compared to other moving to Profmed from other funds. “It shows there is some anxiety about accessing good quality care during pandemic,” he says.

A possible peak

Comrie says medical aid schemes such as Profmed are gearing up for an anticipated peak of COVID-19 cases. “We have confirmed capacity in the hospital groups with which we have contracts. We will continue monitoring occupancy, and if a hospital should be at capacity, we will be able to place Profmed members elsewhere. Our healthcare providers have thus far assured us they feel they can handle the peak period. Pathology groups (which will manage laboratory tests) are also reassuring us of their increased capacity to meet increased demand.”

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