Fewer people in SA are visiting doctors' rooms during the Covid-19 pandemic, but despite the push towards online consultations, telemedicine has not gained the traction expected.
Rose Tuyeni Peter, a health economist at consultancy Percept, said before the pandemic, telemedicine barely existed in SA.
Within weeks of the start of the coronavirus lockdown last year, the Health Professions Council of SA (HPCSA) had published new telemedicine guidelines.
Previously, health-care professionals were not permitted to practise telemedicine if they did not have an existing in-person relationship - involving at least one face-to-face consultation - with a patient. This prerequisite fell away.
But, though the number of in-person doctor visits has dropped in the past year, which Peter attributes to patients being wary of contracting Covid-19 at a health-care facility, there is still resistance from doctors to telemedicine.
Andrew Brown, operations executive at Altron HealthTech, agreed the uptake of telemedicine has been slow.
The technology for telemedicine is "terrific" and works well, but "doctors haven't taken to it" - even though "patients are saying there is no way they are going in" to their doctor's practice.
Altron HealthTech provides the billing system many doctors use. The company said in the first three months of 2020 less than 0.5% of billings were for virtual consultations. This increased to 8% in July and in January this year was 6%.
Brown cited several reasons for the low uptake. A recent Twitter survey conducted by Altron found that a high percentage of patients prefer in-person consultations as opposed to using an online platform. There is also the problem that some consultations require blood tests or other medical services that require a medical practitioner to physically attend to the patient.
— Some doctors are concerned that an online consultation may be less comprehensive and they might miss something about a patient’s well being if the consultation is not in person
Also, whether due to concern about potential legal action or professionalism, some doctors are concerned they might "miss something" and that they will not be able to do a comprehensive consultation online. "They are worried they won't be able to do their job properly," said Brown.
He also raised the discrepancy in the remuneration doctors receive for online and face-to-face consultations. Medical aid schemes pay an estimated R400 per in-person consultation, whereas for a virtual consultation this would be in the region of R250 to R300. This makes it less financially viable for doctors to embrace the technology.
"Doctors aren't being incentivised to use the medium. Money is always a big part of it," said Brown.
There is also the risk private patients not on a medical scheme may not settle their bills after the consultation.
Peter confirmed medical aid administrators usually pay 65% of the usual face-to-face fee for a virtual consultation. She said a new trend of nurse-led telemedicine exists, where a nurse at a clinic can consult a doctor online in a few minutes. This is a scalable model that costs a patient about R200.
The Healthforce service provides nurse-led consultations at certain Dis-Chem pharmacies, Medicare, Spar Pharmacy and independent chemists. A nurse assists the patient and, if a doctor is required, the online platform is activated and a doctor is reached within minutes. Advice, treatment, referrals, sick notes and prescriptions are provided by the doctor.
In September last year, Netcare launched VirtualCare, an online platform to enable doctors to consult with patients. Billy van der Merwe, MD of Netcare's primary care division, said patients of all ages have responded enthusiastically to the service, which is offered across 50 Medicross medical centres nationwide.
Research by Percept found that one tele-triage provider, used for Covid-19 screening, had a 97% success rate in resolving queries and avoiding in-patient consultations. Another
tele-triage provider resolved 80% of its 1,000 calls, saving patients from requiring a physical consultation with a practitioner. In tele-triage, operators evaluate medical information from callers and suggest types of care.
The HPCSA warns against over-servicing patients online but, said Peter, "telemedicine is an option for doctors to continue earning during the pandemic".
Discovery Health's telemedicine offering, launched in 2015, initially had a low uptake but this spiked during lockdown. In January 2021 Discovery received claims for 67,000 teleconsults. Discovery pays 50% of the face-to-face fee for telephonic consultations and 75% for video consultations.
Noluthando Nematswerani, head of the clinical policy unit at Discovery Health, disagreed that reduced remuneration could be a reason for the low uptake of telemedicine. It was rather that doctors are concerned they might "miss something" if they do not evaluate a patient in person, she said.
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