Medical Aid Schemes estimate that they will spend over R2 billion just on COVID-19 testing and treatment. They say they’ve been forced to be strategic about how they manage the global epidemic.

Gems, which covers public servants, says it estimates it will spend close to a R1 billion, while Medscheme estimates their costs at half a billion.

South Africa currently has 1 655 confirmed COVID-19 cases and 11 reported deaths from over 50 000 tests.

Discovery Health looks after 19 medical schemes and has a combined membership of 3.7 million members.

Discovery Health CEO Doctor Ryan Noach says while they haven’t seen a high number of claims, they are however analysing data coming through with each claim.

“This morning we had 455 members on schemes administered by Discovery Health who had tested positive for COVID-19. Of those, about 50 had been in hospital or are still in hospital; some of them have been discharged; 4 of them are in intensive care and unfortunately, one of them has sadly passed away from COVID-19,” says Noach.

A total of 12 000 members have tested for COVID-19 so far.

Noach would not divulge the estimated amount to be spent on COVID-19.

Lower rates

Medscheme, which looks after 17 medical schemes with a combined membership of 3 million, has had to negotiate for lower rates with the pathology laboratories for testing for COVID-19.

Managing Executive at Medscheme Dr Lungi Nyathi says, “We’ve also had to do some negotiations with the pathology labs for better testing. You will remember that when the tests initially came in the private sector, they were just over 1 400 and we’ve been able to negotiate down to 850. It’s where we are now,” says Dr Nyathi.

She says it’s been difficult to estimate because of the uncertainty of the pandemic.

“So when we take a relatively conservative measure and we combine all the schemes that we look after, we think we may get to over half a billion rands, including the number of tests and hospitalisation from the estimates that we currently have,” says Nyathi.

The Government Employees Medical Scheme (Gems), with 720 000 members, estimates that it will spend close to a billion rand in the management and treatment of coronavirus.

“Our actuaries tried to look and they say these numbers have been very volatile and they change from time to time but based on the plus minus 20% of the infection of the entire population then they worked out what could be the scenarios in a Gems environment. It could be anything around R900 million for all the costs of those that will have been proven to have COVID-19,” says Gems Principal Officer, Dr Stan Moloabi.

Medical aid schemes are learning from their international counterparts on dealing with COVID-19 and say adopting telemedicine seems to be the way forward for now, as it protects both patient and medical practitioner from preventable infection.

In this video, Minister Zweli Mkhize discusses the South African healthcare system amid coronavirus: