Medical scheme patients and the scramble for COVID beds

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When COVID-19 beds are in short supply, will medical members be able to jump the queue? Tamar Kahn addresses the “uncomfortable question” in a Business Day analysis.

Kahn says that the response from senior figures in the state health sector, the medical schemes industry and private hospitals has been identical: a long pause, and then a carefully worded commitment that every patient will be treated the same, regardless of who pays.

“We will assess every patient as they come through the door, based on their need,” says Netcare CEO Richard Friedland. Faced with a surge in demand, access to finite resources such as intensive care beds or ventilators may have to be rationed.

“Under disaster management principles you have to apply some form of triage to those who are most likely to survive versus those who are not going to. You have a limited resource, and you have to use it for the best outcome. These are the terrible ethical dilemmas that have faced doctors in Italy, France, the UK and in parts of the US,” he says.

Kahn writes that while this may be fair, such a utilitarian approach will be cold comfort to medical scheme members who assume their premiums guarantee cover for whatever private health care they require. Even if their day-to-day benefits run out before year end, they are usually still able to pay out of pocket for consultations or medication, and rarely wait more than a few days for non-urgent primary health care or more than a few weeks for planned surgery.

Ryan Noach, CEO of South Africa’s biggest medical scheme administrator, Discovery Health, says a patient’s clinical condition should be the sole determinant of the treatment they receive, irrespective of how their care is funded – be it by medical insurance or the state. “We are sure that all South Africans would support this humane approach, though we hope and anticipate that suitable care is readily available to whomever needs it,” he says.

Government Employees Medical Scheme (Gems) principal officer Stan Moloabi says clinicians will decide when and where to admit patients. The constitution reads “everybody has the right to access to health care: I cannot say because I am a member of a medical aid I must have the space reserved in the hospital in case I fall sick,” he says.

Business Day says this unprecedented situation is fast approaching in the Western Cape, which now accounts for 60% of South Africa’s more than 70,000 confirmed cases. It says the Western Cape’s experience negotiating service-level agreements with the private sector is being closely watched by other provinces, which expect their COVID-19 cases to increase in the coming weeks.

Full Business Day analysis by Tamar Kahn

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