Discovery Health Medical Scheme (DHMS) has published new data showing how the coronavirus is impacting its members.
DHMS is South Africa’s largest open medical scheme and, in line with the regulations around medical aids, will fund the costs of tests and treatment for its members who contract the coronavirus.
Discovery said that as of Monday (18 May), it had reported 1,733 coronavirus cases across its schemes. 824 of these cases have been reported in the Western Cape, while 576 cases have been reported in Gauteng.
Of these patients, 412 had to be admitted into hospital, 79 members had to be admitted to ICU and 39 members had to be put onto ventilators. Discovery said that a total of 37 members have passed away.
Discovery said that the cost of the treatment can vary widely based on the acuity of the case, with the current mean sitting at R84,708 per case.
On the lower-end of the scale, patients who were admitted to less severe wards cost a mean of R37,091, while those patients who were put on ventilators cost a mean of R340,737.
When looking at the characteristics of those members which were admitted, Discovery said that older members are most at risk of hospitalisation. This is in line with global trends.
The group said that older members are also more likely to have severe cases and have reported higher fatalities.
Notably, the fatality rate for patients under the age of 70 was reported at less than 4%. However, this increased to more than a third of all members (34.6%) aged 80 years and older.
Commenting on projected figures, chief actuary at Discovery Health in South Africa, Emile Stipp said that the group’s current models align closely with those of government which show that as many as 40,000 South Africans could die from the coronavirus by the end of November.
Discovery Health chief executive officer Ryan Noach said that Discovery was well-positioned to deal with the pandemic, but noted that the country’s medical aids could face finance issues based on the current finances they have in reserve.
Noach estimated that the country’s medical schemes are projected to potentially incur additional claims of between R7.3 billion and R31.8 billion related to the Covid-19 pandemic.
This is equivalent to an additional cost of between R816 and R3,561 per beneficiary for 2020, and the first half of 2021. However, he noted that there have been far fewer claims around elective surgeries and other discretionary payments.
“The Covid-19 expenses will be offset, to some degree, by relatively lower claims for discretionary and elective healthcare episodes during the lockdown period.
“As a result, medical schemes are expected to generate a surplus in 2020, given the decrease, given the decrease in elective hospital admissions in the first half of 2020,” he said.
“Medical schemes expected to need this surplus to cover significant cover due to the potential Covid-19 related admissions and testing costs during 2021.”