Kathy Malherbe speaks to Lee Callakoppen, Principal Officer of Bonitas Medical Fund prior to the Fund’s 2021 launch on the 22 September
Six months into lockdown, South Africa had a dizzying number of rules, restrictions, instructions to contend with and changes from the ‘normal’ way of life. For the healthcare sector, coping with the exponential number of Covid-19 cases meant public and private healthcare and government had to be agile and adapt. In some cases, Covid-19 has accelerated changes that were emerging, but not yet fully fledged, in the healthcare space. These positive trends and acceleration of changes are a good harbinger of things to come, the negative ones a heads up on what to expect and prepare for.
Physical visits to healthcare practitioners dropped dramatically. Not only were people hesitant to visit a doctor, but were also being encouraged to stay at home and practise social distancing. For this reason Bonitas Medical Fund accelerated a programme to offer free virtual care to its members, which extends to non-members for the period of the lockdown.
Over 40 000 people downloaded the app in the first three weeks (both members and non members) and many benefitted from free access to GP consultations for a range of conditions, including Covid-19, as well as free delivery of chronic medicine.
The GP is pivotal
At the heart of the virtual care model is the GP, which aligns to our care coordination initiatives, ensuring members receive the right level of care and support in managing their conditions. It allows access to a virtual nurse, advice in an emergency, auxiliary and home- based care to ensure members have comprehensive support for any condition, in any circumstance. It has been used for a variety of reasons, including general health concerns, requests for updated prescriptions and mental health consultations. We also encourage them to sustain good relationships with their providers as continuity of care is important in terms of patient-provider relationships.
We will continue to monitor these trends as rapid adoption of these channels is likely to occur.
It is by now recognised that a high risk patient, must stick to a medicine regime to keep their health – and lifestyle disease – as stable as possible. This to avoid developing Covid-related complications and generally improve quality of life.
The increased medicine adherence has been pleasing from a disease management perspective, showing us that our members are adopting these self-management steps and taking control of their health.
Studies show that around 20-25% of patients with pre-existing mental health issues feel they are coping badly or deteriorating during the pandemic.
We predict that depression, which has historically been on an upward slope, will increase further in time. Especially due to isolation and social distancing, financial burdens, loss of lives/friends/family members/healthcare workers, the impact on children and the elderly
Post traumatic stress
The Fund is aware that there may be a form of post traumatic stress when lockdown lifts. A slightly delayed response to all the anxiety, fear and depression around the pandemic. Previous epidemic studies have reported high prevalence rates amongst people exposed to the trauma in terms of losing loved ones, directly experiencing the challenging symptoms of, and being hospitalised if Covid-19 positive. Then there is of course the realistic fear of infection, social isolation and stigmatisation. Epidemiological studies have historically demonstrated a high prevalence of mental health problems amongst family members of infected and deceased individuals, survivors, healthcare workers and the general public.
Healthcare practitioners have stressed, from the beginning of Covid-19 that people with comorbidities – two or more conditions at the same time, or one right after the other – are at higher risk of getting seriously ill if they contract Covid-19. Frequently people with other chronic conditions or comorbidities develop mental illness.
It is imperative to treat the patient holistically.
Elective surgeries dropped by over half
There has been a 60% reduction in hospital authorisation requests compared to 2019. A study released in March predicted that an estimated 28.4 million elective surgeries worldwide, would be cancelled during the 12 weeks of peak disruption (longer in South Africa) due to the global pandemic. This has been a similar experience to other industry role players and is predominantly due to a combination of member fears related to Covid-19, lockdown and provider caution.
Surgeries delayed, not cancelled
The postponement of surgeries was done to prevent patients taking up hospital beds and to avoid unnecessarily exposure to the virus – a strategy that worked well to flatten the curve. Providers are best placed to make these clinical decisions in the interests of their patients. If the procedures were emergencies or urgently required to enable member quality of life, those would have proceeded.
We anticipate that alternative care protocols will increase rather than a default to surgery. Treatment protocols such as rehabilitation for neck and back issues, hip and knee replacements will increase and when a C-section is elective, expectant. mothers may go the natural route. The use of day hospitals and clinics will increase, where possible, to limit the possible chance of infection.
Bonitas in 2021
We are looking forward to new and innovative ways of managing our members’ health in 2021 and beyond. Our focus is on more primary healthcare, utilisation of preventative care benefits, digitally enabled solutions and self-help facilities for members who want access to their benefits 24/7. Our goal is to reduce fragmentation of care, enable more access to out-of-hospital services, clinical information and benefits via various alternative solutions. We have listened to our members’ needs and will be rolling out various tools and services to provide additional clinical support, an easier claims process and access to various helpful tools on our website. Our committed to providing quality care, connecting with our customers and driving innovation is unwavering.
What is the future of healthcare?
I believe the future of healthcare is to be agile and innovative in adapting to ever-changing needs from all role players, including providers, facilities, members and the Department of Health. The approach to procurement of equipment, medicine supply management (cost and equitable access), networks, use of day surgeries and acute hospitals and alternative reimbursement models must also be adapted. The increasing use of technology (including health care technologies) and responsible data sharing is essential so that lessons learnt may be shared to enable us to act more swiftly in future when faced with similar uncertainties.
Public/private partnerships will be critical going forward to ensure more equitable access to all South Africans. The time to collaborate with the government is now more than ever – we must not wait for NHI to work towards universal health coverage because we have learnt a valuable lesson. That is, in order for us to survive as a global community, we must address the healthcare of the collective where we are able to.
Other mechanisms to ensure affordability, availability, accessibility and quality care is being accelerated. The changes in healthcare are likely to revolve around preventative care and sustaining well-being as opposed to responding to illness. The member must be at the centre of all the activity, must have access to credible information and empowered to make more informed decisions in the management of his/her treatment.