We have received queries from members and brokers as to whether private medical aid members will be guaranteed a bed in a private hospital, should they need it as a result of COVID-19.
Unfortunately, the short answer is no. Although Fedhealth can guarantee that we will approve funding according to Scheme Rules and available benefits for the treatment and hospitalisation of our members who test positive for COVID-19, the decision as to who will be allocated a bed resides solely with the hospitals, which are the providers. Medical schemes are merely funders, and therefore the actual hospital intake of members falls outside our mandate of service.
In addition, the South African Government reached an agreement with private hospitals to take in government patients who require critical care once government hospitals reach full capacity.
As such, there is simply no guarantee that there will be a bed for anyone, whether they are private patients or not. This is the nature of a global pandemic.
On a positive note
We do however want to reassure our members/ brokers that the National Institute for Communicable Diseases (NICD) guidelines and policies are quite clear w.r.t. the treatment that needs to be provided based on the clinical presentation of the member. These are being followed very closely to ensure that beds are kept open only for those who really require them.
Equipment shortages, Personal Protective Equipment issues and bed capacity logistics are a global phenomenon, and Fedhealth is in constant contact with facilities, providers and the Department of Health to monitor the situation here at home. Together, we are doing our best to ensure appropriate, timeous, effective care and access to as many people as possible.
In certain provinces, license exceptions have been granted by the Department of Health to allow other facilities to perform procedures that are usually only licensed to be done in acute facilities; this is to ensure continuity of care where acute facilities reach capacity.
We are also confident that the national lockdown has contributed to a more manageable situation, and that there will be sufficient hospital beds in the country at the peak of the pandemic.
• If you are admitted for COVID-19 complications (which is a PMB) at a non-DSP hospital, you will not be penalised as no co-payments apply to emergency PMB admissions.
• We highly discourage any elective procedures during this time to limit the unnecessary risk of exposure and avoid placing an additional burden on the healthcare system.
• We encourage the use of day facilities where possible.
These measures may all seem overwhelming, but remember that the current situation is likely to change in terms of provincial pressure and won’t last forever!