Taking on the High Cost of Healthcare
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Taking on the High Cost of Healthcare
| Growing collaboration between leading medical aid schemes and day hospitals is good news for consumers | |
| Medical aid premiums have been growing at above-inflation rates for the last decade or more. Last year again saw double digit increases way above the Consumer Price Index, often accompanied by benefit cuts [1]. These increases are placing increasing burdens on those who are fortunate enough to have medical aid but, at a broader level, they are putting private health care further and further out of reach of the masses. One might even argue that spiralling medical aid costs are contributing to the perpetuation of our divided society. There can be little doubt that the proposed National Health Insurance (NHI) scheme and continuing attempts to regulate the private health care industry are, in part at least, driven by the growing unaffordability of private health care. Day hospitals are a relatively new phenomenon in South Africa. Unlike clinics, which typically provide primary and preventative health care, they are specialist providers of same-day surgical procedures, from dentistry through to gynaecological, orthopaedic, ophthalmological and gastroenterological procedures. By avoiding unnecessary overnight stays, procedures at a day hospital are invariably less expensive than equivalents at one of the traditional, full-service hospitals. For example, in 2014 a patient would have paid about R11 000 through medical aid for tonsillectomy in an acute hospital as opposed to around R8 000 at a day hospital. But there are further benefits for patients. These include state-of-the-art equipment and facilities, top-notch nursing and a much more customer-centric experience. Because a day hospital does not take emergency cases, surgery schedules can be adhered to. When procedures take place on time, the result is a predictable, more pleasant experience as customer testimonials overwhelmingly demonstrate. The focus, at least in our group, is always on the customer but surgeons also find the reliable schedules and up-to-date theatres and equipment a big plus too. It is worth noting that surgeons using our facilities participate in decision-making, so medical considerations remain paramount. Another important point is that the people using a day hospital are healthy individuals who simply require a certain surgical procedure. There is thus a considerably reduced risk of infection, something that people admitted to conventional hospitals are, rightfully, worried about. Traditionally, South African medical aids schemes have used conventional hospitals for all surgical procedures, and this has been a major contributor to high costs. By far the largest percentage of benefits paid out by medical aids in 2015 was to hospitals (37.1 percent). In the light of this, the major schemes are becoming more supportive of day hospitals, and accrediting them as Designated Service Providers (DSPs) so that no co-payment is required by members. Schemes like Discovery, Medscheme, Bestmed and others are actively encouraging members to use day hospitals where it makes sense to do so. Many more schemes are yet to come on board and we are confident that surgeons will increasingly see value in the convenience offered by day hospitals facilities. Like all revolutions, the integration of day hospitals into the health care system is not just about the logic of it; mindsets also have to change. We saw a similar process when medical aids schemes first began to recommend, and then insist on, the use of generics. Many doctors opposed the move, but now generics are integral to responsible health care. Similarly, it is clear that more and more players in the health care sector are seeing the benefits of a specialist day hospital to supplement (and relieve the pressure on) conventional hospitals. But I would argue that pressure from individual consumers would help to speed up progress. They should take the initiative to ask their doctors whether a suggested procedure might not be better handled at a day hospital. In the end, of course, patients will go where their preferred surgeon operates, but showing that they are cognisant of the cost and care benefits of a day hospital will play a role in establishing a “new normal”—one that will benefit everybody. By Bibi Ross-Goss, Group Operational Manager, Advanced Health |
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| Credit To: Ross-Goss, B. (2017, September 21). Taking on the high cost of healthcare. Insurance Gateway. Retrieved from: https://www.insurancegateway.co.za/HealthcareProfessionals/PressRoom/ViewPress/Irn=16471&URL=Taking+on+the+high+cost+of+healthcare#.WddYJFuCyM9 | |
 Refer to the Health or Medical Insurance article |
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