ALTERNATIVE HEALTH PROCESSES
Day hospitals offer many advantages, but South Africans are slow on the uptake
Just a stone’s throw from two major private hospitals in Fourways, Johannesburg, is Cure Day Clinic day hospital, that offers premium care for patients who need minor surgery.
The nearness of the facilities to each other means that patients who need longer-term care can be admitted to the acute hospitals: Mediclinic and Life Healthcare Fourways, while Cure Day Clinic will take care of the rest.
Day hospitals are a recent addition to SA, but more and more of these convenient one-day facilities are cropping up across the country. Already 41 facilities — mostly in Gauteng and the Western Cape — are represented by the Day Hospital Association of SA (Dhasa).
Companies such as Netcare, Mediclinic, Advanced Health and the Cure Day Clinic group are among those that have taken advantage of this international trend — even though South Africans have not yet come to terms with these facilities which experts say offer patients better value for money.
The hospitals focus on the provision of short-procedure surgical services as well as on diagnostic procedures that have to be undertaken in an operating theatre on a same-day basis. Services ideal for such hospitals include plastic surgery, gynaecological, orthopaedic, urological and maxillofacial surgery, and a number of dental, ophthalmic and general procedures.
A shorter stay reduces the risk of cross-infection, to the extent that Discovery Health has also encouraged specialists to operate in day hospitals to save costs, and other schemes such as Gems and Polmed are following suit.
In other parts of the world, day hospitals are frequently used for their convenience, especially their speed and targeted care. According to Dhasa, more than 6,000 day hospitals in the US are used for short surgical procedures.
More of these convenient one-day facilities are cropping up across the country
But demand from South African consumers has not been as strong as it could be. The overall occupancy level of day hospitals is 30%-50%, despite being far more cost-effective for patients and medical schemes.
Advanced Health group operations manager Bibi Goss-Ross says the potential to increase the use of day hospitals is significant as only about 13% of operations are done in them.
Some of SA’s day hospitals were recently recognised as providers of quality healthcare services by the Council for Health Service Accreditation of Southern Africa, a body that helps a range of healthcare facilities to meet and maintain quality standards and so provide safe, quality services.
The cost advantage remains a mixed opportunity for patients. It is no coincidence that day hospitals are often built near acute hospitals. This enables patients to be easily transferred should the need arise, says Econex director Mariné Erasmus.
Hospital fees constitute the bulk of fees paid by medical schemes, according to the Council of Medical Schemes’ 2015 report, with total hospital expenditure amounting to 37.6% of the R124.1bn medical schemes paid to all healthcare providers in 2014. Private healthcare funders paid more than R150bn in 2016.
Healthcare costs are often driven by the cost of importing medicines and machines, volatile exchange rates, doctors’ rates, along with the increasing average age of schemes’ principal members. But in-hospital costs at private facilities remain the biggest costs.
Conversely, hospital group revenues are almost always affected by the number of patient stays and the amount of time they spend in an acute facility. For health providers, another major advantage of patients opting for day hospitals is their potential to reduce collusion between doctors and patients to make fraudulent claims.
In 2013, about R22bn a year was reported to have been paid to corrupt doctors, pharmacists, physiotherapists and pathologists at the expense of medical aid schemes.
SA compares unfavourably with other countries on ratio of medical to dental professionals
The cost model of day hospitals lowers prices for patients says Advanced Health chief financial officer Carel Snyman. The hospital incurs fewer bills to pay and does not bear the costs of large catering facilities, intensive care units and specialised theatres, overnight beds, after-hour staff costs and emergency units. “We offer more reasonable per-minute theatre fees compared with an acute facility,” he says.
Dhasa, which is part of the National Hospital Network, says the cost savings of day hospitals have been confirmed by local medical schemes, many of which have started to incentivise the use of the facilities. Much of the reason for the low uptake is attributed to the fact that many patients are unaware of these facilities, and that they need a doctor’s referral to be admitted. Specialists are few and thinly spread in SA, minimising the chances of referrals.
A study done by Econex on behalf of the Hospital Association of SA concluded that SA compares unfavourably with middle-income countries on the ratio of medical to dental professionals, and many districts have limited access to specialists and subspecialists, even in the private sector where there are fewer doctors per 100,000 people than in most other countries.
Day hospitals can go a long way in maximising the use of some of these scarce resources, including the doctors’ time, while boosting efficiencies.