Virus drives significant changes in the medical aid industry

The Covid-19 pandemic is accelerating much-needed change in the medical aid industry. This is the opinion of Dr Jacques Snyman, medical advisor to Health Squared medical scheme.

According to Snyman, more sustainable approaches to healthcare that better fulfil patients’ needs are being driven by the necessity to manage the challenges Covid-19 presents.

One example is the shift to offering medical aid members more primary healthcare benefits in 2021 so that potential health issues can be addressed immediately when it arises, rather than allowing it to develop into cause for concern. This shift is in line with patients’ increasing preference to access outpatient treatment options.

“The claims patterns we observed in 2020 among our medical scheme members with certain types of medical conditions showed a reduction in hospital admissions, with members instead accessing out-patient treatment options where their condition permitted,” Dr Snyman says.

He adds that healthcare providers have reported that their patients are especially concerned about spending time in healthcare settings unnecessarily due to the risk of Covid-19.

In many cases doctors and specialists have adapted their services to more closely align with their patients’ needs in this regard, if there is no compelling medical requirement for inpatient care.

“Where outpatient care is feasible, the member often benefits from follow-up attention from the provider that may be more focused than is generally possible during hospital rounds, for instance. While this may involve the medical scheme paying for an additional consultation, this is often more cost effective in the long run,” he notes.

Dr Snyman says this tends to improve outcomes and significantly reduces the chances of the member experiencing a repeat health event.

“Members with cardiovascular conditions, for instance, are at increased risk for more severe Covid-19 as well as other types of infections, and it, therefore, makes sense to limit their unnecessary exposure to other patients if there is no medical need for hospitalisation – even beyond the pandemic,” he explains.

He adds that with sufficient primary healthcare benefits, members are less likely to develop more serious health problems in future.

“Often the need for higher levels of care, such as hospitalisation, can be avoided when a person is kept well with benefits that encourage members to access the healthcare they need early on in a properly coordinated and integrated manner.

“The general practitioner at primary healthcare level is ideally placed to coordinate healthcare as they tend to be more familiar with the individual’s health background,” he adds.

An example of such a benefit is Health Squared’s patented Patient Driven Care (PDCG) programme which remotely individually assists members who are at risk due to chronic illnesses.

“By 2020, Patient Driven Care was already well established to proactively support at-risk members, which further protects them through helping to prevent the health events that could place them in hospital,” Dr Snyman adds.

He explains that while the costs of proactively supporting the health of at-risk members may be a little more in terms of their total cost of care, preventable costs are avoided by keeping members well. This is ultimately more cost-effective for the scheme than if the member’s condition were to progress, potentially causing a serious health event, such as a heart attack.

“The pandemic has shown that we can do things differently and better, and we should continue to do so going forward because it has definite advantages for our members,” Dr Snyman concludes.

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