Lockdown claiming private healthcare casualties

The lockdown has started to claim casualties in a section which is crucial not only in the fight against the coronavirus, but healthcare in general – private medical practitioners.

Faced with a 60% decline in patient numbers, cashflow challenges, and concern over being shunned by the public healthcare system – despite showing willingness to join forces in the fight against Covid-19 – private medical practitioners have now come up with a fresh plan to mitigate risk of closure of many practices.

Major medical professional organisations are calling for the mobilisation of the country’s healthcare resources and health workers, to effectively deal with the globally unprecedented and devastating plague.

In the forefront of the all-inclusive campaign against the coronavirus is the Progressive Health Forum (PHF), the South African Medical Association (SAMA), South African Private Practitioners Forum (SAPPF), South African Medical and Dental Practitioners (SAMDP), Radiological Society of South Africa (RSSA) and the Independent Practitioner Associations Foundation (IPAF), have insisted that only an integrated public and private sector approach could provide the best healthcare response to the coronavirus challenge.

Earlier this year, the PHF – a national advocacy network of healthcare veterans, health activists, health workers and professionals from all health disciplines – expressed concern at the public healthcare response to the pandemic.

Dr Aslam Dasoo of PHF said despite private medical practitioners having pledged solidarity with public healthcare professionals, the overture “elicited little traction from government”.

Dasoo said: “When it became clear that the private healthcare system, which in several respects exceeds the capacity of the public, was not being meaningfully engaged by the authorities, despite the obvious necessity, PHF initiated a process to forge collaboration among clinicians in both sectors, to address the pandemic.”

Dasoo said private practitioners faced dwindling patient numbers and “limitations on hospital admissions and surgical procedures”.

“This significant decline in income puts the continuing viability of practices in serious doubt. The stark reality that otherwise viable practices will close is of great concern, because it would impact on the Covid-19 response,” said Dasoo.

The PHF has unveiled an initiative to eliminate risk faced by private medical practitioners.

According to PHF member, Professor Alex van den Heever of the Wits School of Governance, the proposal envisaged private medical scheme funding for practices on “a capitation basis that would guarantee sufficient income for practices for the next 18 to 24 months, while capping the risk to medical schemes”.

Other key features of the proposal include:

• Money being advanced by medical schemes to private practitioners on a non-repayment basis, based on 2019 earnings – involving a guaranteed payment to medical practices of up to 70% of historical claims and 30% based on activities that exceed the 70%. The guaranteed payment will be offset against actual activities as they normalise over-time.
• The global cap being based on both medical savings account and risk benefit claims, with medical, dental and allied practices also being supported.
• Claims activities over the periods 2020 and 2021 being capped at historical 2019 level

Dasoo said that the framework reduced uncertainty for medical practitioners and medical schemes over periods of greatest risk.

Discussions with major health funders on the proposals “have been generally positive and, barring any regulatory impediments, would be supported”.

“While we are confident that the proposal falls within the confines of the Medical Schemes Act, we have consulted the Council for Medical Schemes to fully address any potential regulatory concerns.

“In addition, we have consulted National Treasury in the context of the economic implications of the financial distress of medical practitioners and possible knock-on effect in the wider economy.  Issues raised by all parties have been incorporated into the proposed framework.”

The adoption of the proposal, would ensure that private practices “retain a degree of resilience that will enable them to support government in addressing the pandemic”.

South African Medical Research Council president, Professor Glenda Gray said: “We must be relentless in our pursuit of a response to the pandemic that includes everyone.”

Dr Chris Archer, CEO of SAPPF said the private sector was “ready and willing to participate in the required response”.

“The financial pressure on private practices is real. Unlike their public sector counterparts, who are salaried, private medical practices face significantly reduced income and require funds to honour staff and overhead commitments,” said Archer.

SAMDP chairperson Dr Nkateko Munisi, said family and general practitioners – which he described as “the bedrock of many communities” – faced “devastating consequences”.

SAMA Gauteng chair Dr Mark Human, said private practices saw a 60% decline in patient numbers during lockdown, with some specialists like ophthalmologists, eye, nose and throat doctors; and dentists shutting down “due to the high risk of infection in these specialties”.

“During Level 3, patient numbers have increased, but are still 40% to 50% lower than normal – putting tremendous strain on practices’ ability to survive in the short and medium-term,” said Human.
– brians@citizen.co.za

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