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Progress in Medical Sciences ISSN: 2577 - 2996

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Progress in Medical Sciences. 2021; 5(1):(51-109)

Telephone Consultations by Medical Scheme Patients for Covid-19 Related Diagnosis-2020, South Africa

Michael Mncedisi Willie

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.