Dependence on private healthcare in SA dips due to lockdown
While the arrival of the novel coronavirus in South Africa might have been the worst health crisis in the country in recent times, the dependence on private healthcare appeared to decline significantly this year.
This unusual phenomenon continues to occur during a time when debates rages on around the proposed National Health Insurance (NHI) bill, a financing system that aims to provide universal health coverage for all South Africans which will see both the public and private systems folded into a single entity.
While there are still mixed reactions to the NHI Bill, the government insists it will be introduced with the intention of giving all South Africans access to essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
But the Covid-19 pandemic has now further threatened the existence of private healthcare in the country, with some telling The Saturday Star this week that the use of their services and admission into their facilities this year were relatively low apart from treating those who contracted the virus.
Jacques du Plessis, the managing director of Netcare’s hospital division explained that while they were inundated during the height of the pandemic in the country, they are now witnessing a steep decline.
“Netcare hospitals have seen a steady decline in the number of patients admitted for COVID-19 since the beginning of September,” he said.
“At the height of the pandemic in July as much as 28% of the population tested were positive, whereas that figure is now well below 10%.”
Meanwhile, Dr Ryan Noach, the CEO of Discovery Health said they have witnessed a decline in membership this year.
“Since the outbreak of Covid-19 in South Africa, Discovery Health Medical Scheme (DHMS) has seen a marginal reduction in new members joining the Scheme when compared to prior periods.”
“This is an industry-wide experience, with many purchasing and employment decisions on hold, as well as a period during which financial advisers have worked less due to lockdown restrictions.”
Despite this Noach said that over this same period, DHMS has also seen a marginal reduction in existing members leaving the scheme when compared to prior periods.
“The net effect of lower growth and lower withdrawals on the total DHMS membership has remained constant since the outbreak of COVID-19.”
“The lower withdrawal rate from DHMS is a clear indication that members are choosing to retain medical scheme cover during the COVID-19 pandemic. This cover allows them continued access to out-of-hospital care, and where needed, hospitalisation for all medical conditions, and not just Covid-19.”
Noach added that while their members might have visited medical centres less in 2020 compared to previous years, there has been an increase in the number of employees covered by their Primary Care option, which is Discovery’s low-cost health insurance product which offers affordable access to out-of-hospital primary healthcare, including cover for out-of-hospital Covid-19 treatment.
Meanwhile, there is a growing sentiment that those who can afford private healthcare in South Africa are increasingly emigrating, which would ultimately result in less dependence on medical aid schemes and private healthcare facilities.
But Dr Charl van Loggerenberg, the General Manager of Emergency Medicine at Life Healthcare was unable to pin this down to their members leaving South Africa to live abroad.
“Patient numbers and capacity in any hospital, either private or public, is based on a number of factors, including doctor referrals, health levels of the population and other industry factors.”
“As such, it is not possible to attribute any one variable to patient number increases or decreases.”
As the use of private healthcare declines in South Africa this year for various reasons, there are growing concerns about what the future effects of this will turn out to be.
“We have seen that anxiety relating to Covid-19 and changed behaviours has contributed to people delaying or ignoring routine check-ups and screenings and as a result, we anticipate a growing number of cases of patients who are suffering the effects of delayed screening and treatment for conditions that are potentially curable if detected early, including various forms of cancer,” said van Loggerenberg.
“Furthermore, the same concerns and changed behaviours have influenced people to present less frequently with minor medical complaints and chronic disease management.”
This sentiment was echoed by Du Plessis who said that those who stayed away from medical facilities over Covid-19 fears could see deadly circumstances.
“A disturbing trend some doctors have noted is that the condition of a number of patients with chronic conditions who did not manage their condition adequately over lockdown, have subsequently deteriorated.”
“They report an increasing number of patients who are Covid-19 negative whose chronic conditions have become complicated to the point that they have become medical emergencies.”
He said that routine screenings such as mammograms and check-ups such as for high blood pressure and diabetes are also delayed and that early warning signs of developing health problems may be missed.
Noach added that while Discovery has noted a decline in screening, registration and management of new and existing chronic conditions during the lockdown.
This included a 42% decrease in wellness tests between April and June period compared to the same period in 2019, a 19% reduction in diabetes registrations as well as a 60% drop in HbA1c testing, which is a blood test used to monitor response to diabetes medicines.
He said Discovery is also aware of the 44% reduction in breast cancer diagnoses and a 51% reduction in mammograms performed when compared to the same period last year, as well as 30% fewer GP consultations related to chronic care over the level 5 lockdown period, recovering gradually over the level 3 and 4 lockdown periods.
Despite this, Noach said the Covid-19 pandemic has given them the opportunity to think outside the box.
“The pandemic has accelerated the adoption of digital solutions to meet the demand of health seeking behaviour through digital platforms.”
“It is critically important that South Africans continue to manage their healthcare, either through digital services or in person visits, to prevent deterioration in long term health outcomes.”