Covid-19 bill piles up for medical aids

BONITAS Medical Fund, a medical scheme serving more than 700 000, faces spending an additional R340 million in medical costs due to Covid-19, its principal officer Lee Callakoppen said yesterday.

South Africa’s Covid-19 infections have been spiralling in recent weeks, passing the 150 000 mark, and Callakoppen said the cost projection to the fund was still unpredictable at this stage, due to the uncertainty surrounding the pandemic. Bonitas’s experience provides insight into how medical aids are dealing with the disease.

According to the World Health Organization, current Covid-19 data suggests 80% of infections were mild or asymptomatic, 15% severe requiring oxygen and 5% critical, requiring ventilation.

Up until June 22, Bonitas had 395 Covid-19 hospital admissions, of which 41% had hypertension, 27% were diabetic, 23% had cardiac disease, 11% were HIV-positive and 7% had asthma.

Callakoppen said the number of Covid-19 cases in South Africa was growing exponentially, and the fund was following the data closely, as its members represented roughly 8% of South Africa’s total medical aid membership, and 1.2% of the national population.

Of the fund members infected by June 22, 20% were hospitalised, 5% were treated in the intensive care unit, 60% were treated at home and 20% were asymptomatic or did not require treatment.

The current status of the 395 admissions was that 193 were still in hospital, 153 in a general ward, 13 in high care and 27 in ICU. A total of 165 had been discharged, and there were 44 deaths.

Those needing ICU level of care had an average length of hospital stay of 13.8 days, of which an average of 8.8 days were spent in ICU.

Most of those who died were in the 60-69 age bracket.

Using pathology data up to June 22, the Bonitas test statistics showed that 22 402 people had been tested, or 3.14%, of Bonitas members. About 24 884 tests were performed.

Of these, 1 711 tested positive, or 7.64%. To date, 0.24% of the Bonitas population had tested positive for Covid-19. About R16m had been paid for Covid-19 pathology tests, R13.3m out of risk benefits and R2.7m out of savings benefits.

Callakoppen said there had been a short-term reduction in claims for elective procedures and treatment of less serious conditions, as well as reduced uptake of optical and dentistry benefits during the Covid-19 outbreak, particularly during the lockdown period.

“However, we anticipate that members will access their benefits and undergo treatment such as elective surgeries, based on the advice of their medical professionals during the latter part of 2020 and in 2021. It is possible that these claims will catch up once the spread of the virus has been brought under control and restrictive measures lifted,” he said.