Medical schemes and the coronavirus
Drickus Maartens • March 6, 2020
The Council for Medical Schemes (CMS)
is concerned by the global spread of the coronavirus (COVID-19), particularly
that the epidemic is being fuelled by human-to-human transmission.
“Of concern is the fact that the virus can be spread by individuals who show no symptoms of the infection,” said Dr Sipho
Kabane, Chief Executive and Registrar of CMS.
“We, therefore, encourage all who have travelled to areas with confirmed cases, or have come into close contact with
someone who has travelled, and thereafter experience flu-like symptoms and a fever, to seek immediate medical attention,” continued Dr Kabane. Medical scheme members are encouraged to contact their medical schemes on their benefit option entitlements if they experience flu-like symptoms. All testing for the coronavirus should be referred to State laboratories and not private labs, as advised by the Department of Health.
“As the virus progresses it may result in various complications, such as pneumonia and respiratory failure which then,
should be treated as Prescribed Minimum Benefit (PMB) level of care,” said Dr Kabane. In cases of uncomplicated infection where there are no PMB-eligible conditions, the medical scheme may fund all health care costs as per scheme rules.
High-risk individuals — members with pre-existing conditions such as pregnancy, diabetes mellitus, asthma, cancer, HIV and other immunosuppressive conditions — are urged to keep up with their routine medication and screenings. Individuals over the age of 50 and children under the age of 10 years are also encouraged.
“All medical schemes are required by law to pay for the diagnosis, treatment and care costs of PMB conditions in full
irrespective of plan type or option. They are not allowed to fund PMB conditions from a member’s Medical Savings Account, as this is not in line with the PMB Regulations,” concluded Dr Kabane.
PMBs are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health
services, regardless of the benefit option they have selected. They are a feature of the Medical Schemes Act of 1998,
and medical schemes have to cover the costs related to the diagnosis, treatment and care.
As the regulator of the medical schemes industry, the CMS is committed to ensuring that there is effective coverage for all conditions that members may suffer from, including any complications of the coronavirus. “We encourage medical schemes to provide comprehensive cover for all confirmed cases, in the interest of public health,” concluded Dr Kabane.
To prevent the spread of the coronavirus, global authorities, including World Health Organization (WHO) and the South African National Institute for Communicable Diseases (NICD) recommend good practice of hand hygiene (handwashing with soap and water), cough etiquette, avoiding contact with animals when in high-risk countries, and adhering to the following:
- Avoiding close contact with people suffering from acute respiratory infections
- Frequent handwashing, especially after direct contact with ill people or their environment
- Avoiding visiting markets where live animals are sold
Finally, non-essential travel is discouraged, especially to high-risk countries.
The CMS issued a CMScript Newsletter on the coronavirus. Find it here.
It has been estimated that 80% to 90% of doctors experience some form of burnout at some point in their careers. This can affect their ability to practise optimally and to connect with their patients with empathy and care. The consequences are serious, as burnout and depression are major risks for doctors, threatening both their wellbeing and the quality of care they provide.
Upbeat 25-year-old student Atang Climantine Makhubedu jokingly calls herself a cataract survivor. Just weeks before, however, she was battling the harsh reality of unexpected vision loss, which Dr Sachin Bawa, an ophthalmic surgeon practising at Netcare Linkwood Hospital, describes as having significantly impacted Atang’s daily life.
A South African first of its kind tool is transforming patient care locally by leveraging Netcare’s advanced electronic medical records system and abundant clinical data. This will help clinicians identify risk of deterioration from common causes earlier among intensive care patients so that treatment can start sooner.
Ditshegofatso Kgobisa, known as ‘DK’ for short, suffered kidney failure at 15. After 11 months reliant on lifesaving dialysis with National Renal Care, DK gained a new lease on life after his mother, Rosemary, was able to donate one of her kidneys to him.
Migraines affect 15% of the global population, causing severe pain and disrupting daily life. Neurologist Dr. Michael Huth emphasises the importance of understanding different migraine types and their triggers.
Dr Michael de Villiers explains why people can become sick every flu season and why the influenza vaccine is generally recommended every year.
Colorectal cancer, one of the most prevalent yet preventable cancers, can develop in the colon or rectum, often starting as small polyps that can quietly become malignant if left unchecked. Dr Mpho Ramabulana, a colorectal surgeon and gastroenterologist at Netcare Akasia Hospital, underscores the life-saving power of vigilance and the importance of early detection.
Cardiologist Dr Robert Routier urges the public to check their personal risk factors regularly to help prevent or manage cardiovascular disease.
The physical strain pregnancy puts on an expectant mother’s body should not be underestimated. An obstetrician gynaecologist offers her insights for alleviating discomfort and promoting wellbeing with exercise and stretching throughout pregnancy.
Dr Patience Sigwadi, a leading paediatric nephrologist practising at Netcare Unitas Hospital in Centurion, has issued an urgent call for increased focus on skills development to address the escalating kidney disease crisis among children in South Africa.
