“The claims patterns we observed in 2020 among our medical scheme members with certain types of medical conditions showed a reduction in hospital admissions, with members instead accessing out-patient treatment options where their condition permitted,” Dr Snyman says. 

“Healthcare providers have reported that their patients are especially concerned about spending time in healthcare settings unnecessarily due to the risk of COVID-19, and in many cases doctors and specialists have adapted their services to more closely align with their patients’ needs in this regard, if there is no compelling medical requirement for inpatient care. 

“Where outpatient care is feasible, the member often benefits from follow-up attention from the provider that may be more focused than is generally possible during hospital rounds, for instance. While this may involve the medical scheme paying for an additional consultation, this is often more cost effective in the long run,” he notes.

“This tends to improve outcomes and significantly reduces the chances of the member experiencing a repeat health event, so naturally it is better for the member’s health and it is also more sustainable for the medical scheme.

“Members with cardiovascular conditions, for instance, are at increased risk for more severe COVID-19 as well as other types of infections, and it therefore makes sense to limit their unnecessary exposure to other patients if there is no medical need for hospitalisation – even beyond the pandemic.”

Dr Snyman points out that the country’s hospitals have faced severe pressure with the second wave of COVID-19, indicating that the level of care available in the acute hospital setting should be reserved for those who really require it.

“Helping our members remain healthy through access to good benefits to support physical and emotional wellbeing, as well as preventative care, is one aspect of this. When a person has sufficient primary healthcare benefits, they are less likely to develop more serious health problems in future,” Dr Snyman says.

“Often the need for higher levels of care, such as hospitalisation, can be avoided when a person is kept well with benefits that encourage members to access the healthcare they need early on in a properly coordinated and integrated manner. 

“The General Practitioner at primary healthcare level is ideally placed to coordinate healthcare as they tend to be more familiar with the individual’s health background. For 2021, Health Squared offered members more primary healthcare benefits, as per the demand identified in 2020, so that a potential health issue can be addressed immediately when it arises, rather than allowing it to develop into cause for concern.”

Managing existing chronic conditions effectively can significantly reduce the risk of a person developing more severe COVID-19 complications. Dr Snyman points out that members of Health Squared who are at risk due to chronic illnesses have always been individually assisted remotely through the patented Patient Driven Care (PDCTM) programme to monitor and manage their condition, and the value of this was further highlighted by the pandemic and need for social distancing. 

“By 2020, Patient Driven Care was already well established to proactively support at-risk members, which further protects them through helping to prevent the health events that could place them in hospital. Taking better care of our members in this way makes financial sense for the wider memberships’ scheme funds too,” Dr Snyman adds. 

“While the costs of proactively supporting the health of at-risk members may be a little more in terms of their total cost of care, preventable costs are avoided by keeping members well. This is ultimately more cost-effective for the scheme than if the member’s condition were to progress, potentially causing a serious health event, such as a heart attack. 

“The pandemic has shown that we can do things differently and better, and we should continue to do so going forward because it has definite advantages for our members,” Dr Snyman concludes.