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The impact of lockdown of medical aid members

03 November 2020 Lee Callakoppen, Principal Officer of Bonitas Medical
Lee Callakoppen

Lee Callakoppen

2020 has been a disruptive year with the impact of Covid-19 and the subsequent lockdown impacting everyone. The long-term implications, economically and in terms of health, will be felt for years. We asked Lee Callakoppen, Principal Officer of Bonitas Medical to provide some insights into how members have coped during this time.

What role did chronic conditions play during lockdown

One of the biggest lessons learned is the impact lifestyle diseases and comorbidities have on Covid-19 patients. These include high blood pressure, diabetes and obesity - which increases the risk significantly of getting seriously ill with the coronavirus. 

When Covid-19 became a reality, the first step was to identify our high risk members. We put interventions and communications in place to ensure these 30% understood the importance of sticking to the protocols, maintaining their medication regime and eliminating as much risk as possible. We also monitored the medicine supply chain and implemented measures between pharmaceutical and courier companies to ensure chronic medication was delivered to member’s homes. 

Even without the pandemic, we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions.  Managed Care is key. It’s about encouraging and empowering members to take charge of their health and to support them on their path to wellness. 

You mention Managed Care being key. We know Bonitas has a Managed Care programme to assist members with chronic conditions such as back and neck pain, diabetes, mental health issues.  How were these affected during lockdown?

Members have not been utilising non-critical health services during lockdown due to fears around social distancing and contracting the virus. 

Back and neck programme

In terms of the back and neck programme we saw a marked decrease in enrolment.  Only 370 members joined the programme as opposed to a normal average of around 600. The lowest numbers were seen in April when lockdown commenced. 

Specialist visits

Again there was a marked decrease in consultations and check-ups which is a concern.  When dealing with a chronic lifestyle disease it is imperative that members are monitored continuously, to pre-empt any serious developments. However consultations are increasing once again and, although providers in general are likely to remain prudent, we are urging our members to go for their annual check-ups, particularly high risk members. 

Mental health

Studies show that around 20-25% of patients with pre-existing mental health issues feel they are coping badly or deteriorating due to Covid-19.  Previous epidemic studies have reported high prevalence rates amongst people exposed to trauma in terms of losing loved ones, directly experiencing symptoms, being hospitalised if Covid-19 positive and experiencing the fear of infection, social isolation and stigmatisation. Historically a high prevalence of mental health problems manifests amongst family members of infected and deceased individuals, survivors, healthcare workers and the general public. 

Our Covid-19 call centre, created in April 2020 to provide additional telephonic support to all members, flagged mental health was a priority.  

We have around 28 000 unique registered beneficiaries with mental illness, 1 700 members have enrolled on the mental health programme and adherence to chronic medicine is 91.4%.  

What about elective surgery?

In South Africa, elective surgery in both the private and public healthcare space and specialists’ visits are just two of the role players affected by Covid-19. The link between the two is clear – fewer specialists’ visits mean fewer referrals for surgery.  

In March it was predicted that around 28.4 million elective surgeries worldwide will be cancelled during the 12 weeks of peak disruption due to the pandemic. We have seen a 60% reduction in hospital authorisation requests compared to 2019.                                       

On hold - not cancelled

Elective surgeries were put on hold to prevent overcrowding and to ensure patients were not unnecessarily exposed to the virus – a strategy that worked well to flatten the curve.  These surgeries were delayed based on provider discretion and subsequent patient engagement. 

However, providers are best placed to make these clinical decisions in the interest of their patients and elective surgeries are now almost back to normal. The backlog of surgeries, not considered emergency during lockdown, is being addressed. These include slow-growing cancers, orthopaedic and spine surgeries, airway surgeries as well as heart surgeries for stable cardiac issues.  

We caution against a rush of elective surgeries though. Any surgery has an impact on the immune system which means the patient has a greater risk of contracting Covid-19 and developing complications from it. 

What about screening and testing for cancers?

Members have still been testing but at a reduced rate. Mammograms done between 2019 and 2020 have reduced by 3% and prostate tests have, on average, reduced by 7%.   This is not ideal as there is the risk of picking up cancers at more advanced stages. 

Was there any impact on members on HIV/Aids  programmes?

The Government amending the Medicines and Related Substances Act for Schedule 2, 3 and 4 drugs ensured that members had access to medication.   

The lockdown had a low impact on members living with HIV due to our strategies to ensure they remained adherent to their ART’s. Monthly adherence communications are sent to members and treatment support focused on the members that were non-adherent to ART as well as members that were not suppressed. Stock outages were expected but mitigated by updating authorisations for members. 

Pathology result volumes remained consistent as in the months prior to lockdown.

In the second quarter, 796 new members registered on the programme and in the third quarter  there were 696 new member registrations.  

Do you think there will be long-term health implications for your members?

We put various measures in place to ensure we communicated with our members, to provide them with accurate information about Covid-19 and to encourage them to follow the protocols to remain safe.  Our high risk members were interacted with more frequently and we made sure their medication was delivered to maintain their healthcare wellness regime.

Our call centre was amplified to be of assistance 24/7. 

We hope the interventions– including Virtual Care - and the proactive communication introduced via various platforms have been positive and that we will not see long-term health impact on our members.

However, we know there will be a rise in mental health issues but, at this stage the medical fraternity is unclear on the after effects of Covid-19.  This means we need to remain vigilant in the management of our member’s health and to continue to provide quality care and remain connected with our customers.  

 

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