Private and public healthcare will have to bridge gulf in event of Covid-19 epidemic

Covid-19 is already putting health systems in a number of developed countries under considerable strain – with ICU beds and ventilators in particularly high demand.

As of Wednesday 11 March, South Africa had only 13 confirmed cases of Covid-19. But if the infection rate were to rise as rapidly as it has done elsewhere, there is little doubt that the already failing public health system would be unable to cope.

Under ordinary circumstances, the insufficient number of ICU beds in public hospitals is already a problem. In 2019, the cancellation of thousands of operations annually at both Charlotte Maxeke and Baragwanath hospitals in Gauteng was attributed in part to a shortage of ICU beds.

In the event of a large-scale Covid-19 outbreak, a complicating factor would be that people diagnosed with Covid-19 need to be isolated quickly in hospitals before the virus can spread to hospital workers, other patients or family members. The isolation requirements are clearly at odds with the overburdened nature of many of South Africa’s public hospitals.

This is where South Africa’s private medical facilities could play an important role. In 2016, the Gauteng Health Department estimated that there was a roughly 50:50 split of hospital beds between private and public facilities in the province.

The problem? Only around 16-17% of South Africans are covered by medical aid which would support treatment in private facilities.

But experts say it is untenable for private medical facilities to reserve their resources for those who can pay at a time like this.

“If we are to contain Covid-19 in South Africa, the private health sector – providers, hospitals, pharmacies, emergency services etc – will have no choice but to come to the party and share their resources,” University of the Western Cape public health professor Helen Schneider told Daily Maverick.

UCT School of Public Health Professor Lucy Gilson agrees.

“As human beings and as a community we have a responsibility to assist each other, and particularly those most vulnerable, in every way we can if the epidemic progresses at scale and speed, as elsewhere,” Gilson told Daily Maverick.

“That might well need to include the sharing of resources between private and public sectors – recognising that this resource sharing would be in all our interests. Extraordinary times demand extraordinary responses.”

The Department of Health is currently remaining tight-lipped on factors relating to the logistics of treating a potential Covid-19 epidemic in South Africa.

Spokesperson Lwazi Manzi told Daily Maverick that she could not comment on whether talks are currently underway between the government and the private health sector to make resource-sharing arrangements.

The biggest private healthcare companies in the country, however, have confirmed to Daily Maverick that such discussions are ongoing.

Mediclinic’s chief clinical officer, Dr Stefan Smuts, said: “We are working closely together with the national and provincial [departments of health] on facility preparedness, along with how we can collaborate in addressing the [Covid-19] outbreak, including how we can address the capacity constraints in both public and private [sectors]”.

The medical director for the Netcare group, Dr Anchen Laubscher, told Daily Maverick that Netcare is “collaborating closely” with both the Department of Health and the National Institute for Communicable Diseases (NICD).

Said Laubscher: “We remain fully committed to offering our full and ongoing support to them, as well as the people of South Africa, and will assist in any way we are able, in the event this should ever become necessary.”

Melomed Private Hospitals pointed out that no private facility in South Africa can refuse to administer emergency treatment, in terms of section 27 of the South African Constitution.

“Melomed Hospitals have and will always provide emergency treatment to all persons who present themselves at our emergency units,” spokesperson Shameema Adams told Daily Maverick.

Yet, while these assurances are comforting on paper, the question of how such resource-sharing would actually look in practice is likely to be far more complicated – and to potentially provide a test run for the implementation of the National Health Insurance.

“The point is, who carries the cost and what that cost is,” says Wits professor of public health Sharon Fonn.

“I think that some realistic costing has to be done, and while the state may have to pay something, I think it cannot be private sector rates – and it seems that this is what the conversation should be about.”

Fonn also suggests that it may be necessary for the state to commandeer human resources to respond to such a crisis, after ensuring that all provincial staff are already at work.

“Private practitioners, trained at the cost of the state, [might have to be] put on to rosters and work under the supervision of [heads of departments] in the designated Covid-19 public facilities as well. Here the cost is not that hard to work out, as it can be a pro-rata amount based on hospital salaries.”

But it is likely that some of the private sector costs associated with responding to a crisis might eventually be passed on to consumers.

As an illustration of this, the CEOs of major health insurance companies in the US appeared alongside Vice-President Mike Pence this week to announce that the costs of coronavirus testing would be waived for members. But US analysts have already warned that the unexpected cost burden the coronavirus is presenting to health insurers will probably translate into higher premium prices in 2021.

In South Africa, a similar situation might play out. Local medical aid giants Discovery Health, Momentum Health and Profmed have said that members will not pay for testing (though in at least one case – Discovery – the cost waiver only applies if the test returns positive). In the long run, the costs associated may well be recouped from medical aid premiums across the board.

In the short term, South Africa’s private sector at large has a chance to prove its commitment to making a positive contribution. Businesses might consider taking a lesson from their counterparts in countries like Singapore, where some companies have distributed free hand sanitiser.

Ultimately, the gulf between private and public healthcare in South Africa will have to be bridged in the event of a Covid-19 epidemic. There will be no other option.

“This is a good moment to remind us that health is a right, and not a commodity,” says Schneider.

“We should all have access to the healthcare we need, and not the healthcare we can afford to pay for — both to protect the health of ourselves and our families, and to prevent the spread of outbreaks like Covid-19.” DM