Progress in Medical Sciences. 2021;
5(1):(51-110)
Telephone Consultations by Medical Scheme Patients for Covid-19 Related Diagnosis-2020, South Africa
Michael Mncedisi Willie
Abstract
Background: The COVID-19 epidemic has adversely affected health systems globally. The utilisation of
technology and other innovative channels link up with patients has evolved drastically in the COVID-19
climate. Lockdown measures and COVID-19 regulations and the fear of contracting the virus at a health
care facility has also changed health seeing behaviour among patients. The COVID-19 climate has seen a
significant increase in the utilisation of virtual platforms to consult with providers.
Objectives: The primary objective of this study was to conduct the descriptive analysis of telephonic
consultations by members of medical schemes.
Methods: The study entailed a descriptive comparative analysis of medical schemes’ claims data. This
was mainly outpatient claims information with the service date between March – December 2020. The
inclusion criteria were all NAPPI codes associated with a telephonic consultation. The study included only
COVID-19 related ICD-10 code primary diagnosis.
Results: The analysis covered claims data from a total of 12 medical schemes. The schemes analysed
accounted for 1,6 million lives, on 2019 beneficiaries. The total number of COVID-19 confirmed diagnosisrelated
telephonic consultations was 8 939 and those related to suspected diagnosis accounted for 12
608, (41% vs. 59%, p<0.001). The median claims amount for a COVID-19 confirmed diagnosis and that of a
suspected diagnosis was IQR: R293 (R283-R400) and R288 (R283-R390), respectively.
Conclusion: The study found evidence of patients utilising digital platforms to consult the respective
practitioners during the COVID-19 pandemic. Greater utilisation patterns were seen in disciplines such as
general medical practice, specialists’ family medicine, independent practice specialist medicine and group
practices. The main finding of the study was disparities between the scheme tariff amount and the claimed
amount. The findings of this study depicted multidisciplinary management of COVID‐19, particularly at a
primary health care level, where patients could consult with a practitioner virtually. However, we warn of
ethical considerations and risk-related issues such as fraudulent activities that could arise when consulting
medical practitioners virtually.
