Lee Callakoppen: BizCommunity, 7 January 2021 •
Callakoppen is principal officer of Bonitas Medical Fund
GLOBALLY, day surgery hospitals have changed the experience of patients by offering an alternative to acute/conventional hospital surgery. In South Africa, the concept is also gaining popularity – particularly as a result of high hospital costs. Using our hospital dashboard for the full 2019 year, direct hospital costs were 43 percent of the total scheme expenditure. These excluded doctor and allied services while a patient was in-hospital.
The increase in the use of day hospitals
Internationally there is a trend in increased day surgery for multiple reasons including:
• Improved anaesthesia (with quicker recovery period);
• Improved pain control (anaesthetic blocks and improved medication);
• Instrumentation and procedures (keyhole surgery).
Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+ percent. They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund. We negotiate special rates through our hospital networks and designated service providers (DSPs) and encourage members to use managed care initiatives. Encouraging members to use day hospitals is another way in which we can save on costs. That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities.
Other advantages of day hospitals
• No overnight stay – patients are admitted, operated on and discharged on the same day;
• Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same-day surgery as the trauma of overnight stays are eliminated;
• Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery;
• Mortality and major morbidity are extremely low (<1%)
• Improved surgery scheduling – decrease in waiting lists.
Why is take up not higher?
Day hospitals clearly have marked advantages, but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape. There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason. The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome. This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74 percent and 26 percent in day hospitals. This implies that 74 percent of all procedures which could be performed in a day hospital are currently performed in acute facilities.
Safety is foremost.
Not all patients can go to day hospitals. It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.
Will day hospital use be enforced?
The Day Hospital Association of South Africa has proposed that medical aids enforce day hospital use in the future but also caution that there are some cases which cannot be carried out in day hospitals. There are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.