**5. Results**

The analysis covered claims data from a total of 12 medical schemes. The schemes analysed accounted for 1,6 million lives. The total number of telephonic consultations was 17 237. The mean (SD) claimed amount for telephone consultation for a general medical practice consult was R2827 (SD = 20). This was slightly lower than the scheme tariff of R2878 (SD = 19) (**Table 2**).

**Figure 1** below depicts the proportion of consultations per month. The results depicted a peak in the proportion of consultations in July and December, with July accounting for 33 percent and 22 percent of consultations in July and December, respectively. This phenomenon was consistent with COVID-19 infection rates at a national level in South Africa.

The study found that most telephonic consults were for Acute bronchitis, unspecified; Acute upper respiratory; Emergency use of U07.1 (Confirmed diagnosis); Emergency use of U07.2 (suspected diagnosis); Follow-up examination; Special screening. **Table 3** below further depicts that average consults for an acute respiratory

<sup>7</sup> 14.2 GBP

<sup>8</sup> 14.4 GBP


**Table 2.**

*Summary statistics: Claimed amount vs. scheme tariff amount- general medical practice telephone consultations. (1 R: 1 ZAR = 0.0503 GBP).*

**Figure 1.** *Total number of telephone consultations per month to general medical practitioners.*

consult were higher at R298 (SD = 103). However, there was variability in this regard. The average claim amount for a COVID-19 confirmed diagnosis was lower than the suspected diagnosis at R284 (SD = 27) and R288 (SD = 83), respectively.

**Figure 2** below depicts a Box and Whisker plot of the average claim amount for the general medical practitioner telephonic consultations. The findings depict that the most prevalent telephone consults were mainly for general medical practice, specialist family medicine depicting outliers. The average claim amount per telephonic consults for other specialist telephonic consults for Independent Practice Specialist Obstetrics and Gynaecology was higher than R400. Their results also showed some evidence of telephone consultation for non-consulting specialists such as Urologists and Paediatrics Independent Practice Specialist though the volumes were not as significantly high.


#### **Table 3.**

*Summary statistics: Claimed amount per ICD-10 primary ICD-10 code description- general medical practice telephone consultations. (1 R: 1 ZAR = 0.0503 GBP).*

*Telephone Consultations by Medical Scheme Patients Consulting General Medical Practitioners… DOI: http://dx.doi.org/10.5772/intechopen.98496*

#### **Figure 2.**

*Box and whisker plot - telephonic consultations (claimed amount) by discipline. (14 = general medical practice; 15 = specialist family medicine; 16 = independent practice specialist obstetrics and Gynaecology; 18 = independent practice specialist medicine; 30 = otorhinolaryngology; 32 = Paediatrics independent practice specialist; 42 = surgery independent practice specialist; 44 = cardio thoracic surgery; 46 = urology; 50 = group practices).*

#### **6. Discussion**

The objective of this paper was to explore and assess telephone consultations among members of medical schemes in South Africa. This study found that telephone consultations were mainly for general medical practice services with an average claimed amount of less than R300 per telephone consultation. The average claimed amounts in this study were within the ER Consulting estimates of between R270 and R330 (ER Consulting, 2020). The amount claimed for virtual consultations ranged between R281 and R437, and these were similar to rates depicted earlier in this study [13]. The study also found telephone consults among specialist services, and these had an average claimed amount higher than R400, reflecting the specialist level of care by these specialists which attract higher reimbursement rates. A study conducted in Frace found that a large proportion of teleconsultations (96 percent) were billed by private practitioners [12]. This study also explored the average claim amount per general medical practice telephone consultation on six different diagnoses. The study found similarities among these average claims per telephone consultation, which also included follow-up examination and special screening exam. A notable feature of the findings was that the average claim amount for an acute upper respiratory telephone consult was higher than COVID-19 confirmed diagnosis or COVID-19 suspected primary diagnosis consultation. There are currently no pricing guidelines across various specialists and practitioner telephone consultations in South Africa, at least at the time of writing this Chapter. According to Hammersley *et al.,* remote consultations are perceived to be less "information-rich" than face-to-face consultations, and technical issues were common [19]. Hobbs *et al.* found that telephone consultations were usually shorter than face-to-face consultations (mean duration 5.4 minutes compared with 9.22 minutes [20]. A study by Hewitt, Gafaranga and McKinstry found no underlying contrasts between the communicative practices used in face-to-face and telephone

consultations [21]. Further research is projected to further investigate the varying reimbursement rates for various specialist groups and other disciplines relative to a face-to-face consultation. Future research should also seek to develop guidelines on telephonic consultations and assess value add to patients.
