The Board of Healthcare Funders (BHF) and its members in the healthcare funding space have requested members of medical schemes to proceed with caution in scheduling elective surgical procedures. Where the risk of in-hospital patient exposure to Covid-19 may be high, members of medical scheme are requested to engage their health practitioners and consider deferring elective surgeries that are not a medical emergency.
The South African Police Service Medical Scheme (Polmed), Bonitas, Universal Healthcare, Metropolitan Health Group, and CompCare Medical Scheme, among others, have all echoed the same concerns around deferring elective surgeries to minimise risk of Covid-19 infections.
Dr Rajesh Patel, Head of Benefit and Risk at the BHF, says, “While the relaxation of the lockdown restrictions is good news for people, the country and the economy at large, we are still in the eye of the storm.
“Members of the public must tread with caution and only undergo medical procedures that are absolutely necessary and certified to be lifesaving by their medical practitioner. This is to avoid reversing some of the small gains that have been made in containing the spread of the coronavirus,” says Dr Patel.
Dr Ali Hamdulay, CEO of Metropolitan Health Group, says the relationship between a healthcare practitioner and a patient remains particularly important. “Within the context of Covid-19 it’s critical that patients engage their healthcare practitioners to understand the implications of proceeding with procedures during this time to fully understand the risks associated with undergoing elective surgery.”
Lee Callakoppen, Principal Officer of Bonitas Medical Fund, says, “While all screening, clinical and hygiene protocols may be adhered to, there is no guarantee that members will not contract Covid-19 while undergoing elective surgery, especially as infections continue to peak.
Callakoppen said, “We strongly advise that more severe surgeries should be prioritised, and surgeries that are not high acuity be placed on hold. Elective surgeries should be resumed in instances where not undergoing surgery would severely impact the member’s health.”
Polmed’s Principal Officer, Neo Khauoe, advises that, “A number of considerations should be taken before undergoing elective surgery, as the possibility of members contracting infections is a reality. It is possible for members go into a hospital in a healthy state and then contract a potentially life-threatening infection whilst in hospital. It’s therefore critical that practitioners and patients weigh up the risks vs the benefits of undergoing elective surgery during this time.”
Khauoe emphasises that we all need to recognise that, although the lockdown regulations have been relaxed, the Covid-19 pandemic is not over yet, and movement should remain limited in order to protect each other from contracting the virus.
Geraldine Bartlett, Chief Professional Officer of Universal Healthcare, concurs. She points out that though the easing of the lockdown restrictions has brought some freedom, it also presents more risks. “We are still in the upward stage of the Covid-19 pandemic in our country, which means that we are likely to see more and more new Covid-19 cases. Far from relaxing our guard at this time, we should continue to strengthen the measures being taken against the spread of the virus,” she says.
According to Bartlett, elective surgeries, which include knee and hip replacements, ligament repairs, hernia repair, etc, could significantly add to the burden on healthcare resources and keep hospital beds occupied ahead of an expected surge in serious novel coronavirus cases requiring hospitalisation.
Mark Bayley, Managing Director: Administration of Universal Healthcare, also emphasises that one of the reasons why private hospital groups placed a hold on all elective surgeries was to give these facilities much-needed capacity to attend to coronavirus cases and prevent them from becoming unintended incubators of the pandemic.
“Now that hospitals have permission to undertake elective surgery we should tread very carefully, as major surgery can have a major impact on the immune system, which means that those who have undergone such a procedure, would not only be at greater risk of contracting the Covid-19 virus but also of suffering a much more serious case of the disease,” says Bayley.
Both Bayley and Bartlett strongly advise patients who are on chronic medication, such as for treatment of HIV/AIDS, tuberculosis, hypertension and diabetes, to take extra precautions, as they are most vulnerable to contracting the deadly disease. According to figures released by Stats SA, there are approximately 7,5 million people who are living with HIV in South Africa.
“We urge patients who have been diagnosed with a chronic illness to continue to have their medical condition managed in close consultation with their healthcare practitioner and to ensure that they take their medication as prescribed,” says Bartlett.
“Should these patients feel concerned about visiting their doctor, they can opt to have remote consultation and request their pharmacy to deliver their medication. AIDS patients who fail to take their regular doses of ARVs are not only likely to be more vulnerable to Covid-19, they are also at risk of developing a range of HIV-related complications. This underscores the importance of this population taking their medicines as prescribed.”
Josua Joubert, Chief Executive and Principal Officer of CompCare Medical Scheme, explains that while the term “elective surgery” might suggest that this type of surgery is optional, this is not always the case.
“An elective procedure describes a surgery that is planned in advance rather than one that is necessarily optional. In some instances, when such a medical procedure is performed to treat a serious medical condition such as some types of cancer, or where the pain may be overwhelming, an elective operation may be considered urgent. If it’s not life threatening, then we urge our members to consider deferring such procedures to a later date.”
Dr Patel confirmed that the BHF has reached out to the Hospital Association of South Africa (HASA) and the Facility Management stream under the BUSA Collaborative to establish a technical advisory subcommittee made up of participants from funders and hospitals to agree on protocols and definitions for these urgent or time-sensitive procedures, given the complex environment and consistently changing guidelines around Covid-19.
According to the BHF, all stakeholders are currently engaging around the setting up of this technical subcommittee and draft procedures have been put on the table and are being reviewed.