Public Health & Health Systems

Poor service also at private hospitals

There is a big difference between hospitals in the private sector in much the same way that there are wide disparities in care across public health facilities and provinces, according to Discovery Health CEO Dr Jonathan Broomberg.

Some private dialysis units in the country may not be following standard protocols, exposing patients to infections, Broomberg says.

Some private dialysis units in the country may not be following standard protocols, exposing patients to infections, Broomberg says.

Data collected by the country’s largest medical aid, Discovery Health, over a four-year period shows that a patient’s survival even in the private sector depends on which hospital they are admitted to.

Between 2008 and 2011, about seven percent of Discovery members admitted to hospital following heart attacks died, a percent

age that is on a par with figures from the European Union.

But this figure masks mortality rates as low as one percent and as high as almost 30 percent among the 109 hospitals Discovery surveyed.

While varying numbers of patients and different disease burdens could account for some of this variation, Broomberg says what is clear is that some private hospitals are not following basic protocols.

“You wouldn’t expect quite that degree of variation if standards were the same,” said Broomberg, speaking at a recent media briefing. “When you look at acute heart attacks, there are certain protocols that are known around the world and that are absolutely essential to do right up front.”

“When people arrive they should be given aspirin (and) a medicine called a beta blocker – there’s a protocol,” he told Health-e News. “I can tell you that in many emergency rooms throughout the country those basic protocols aren’t followed.”

The problem is not contained to emergency rooms. Discovery Health has seen similar variations in quality among its about 6 000 dialysis patients. According to Broomberg, poor quality dialysis sets patients up for infections, re-admissions and death.

“There are set protocols based on best global evidence,” he told Health-e News. “To be very honest, it’s just not acceptable that all units in the country aren’t sticking to those protocols.”

The devil is in the data

[quote float=”right”]“It’s just not acceptable that all units in the country aren’t sticking to those protocols.”

Driving these wide gaps in private care is a highly fragmented system and a lack of data that allows hospitals to monitor and react to poor care, said Broomberg.

It is the same sort of data problems the country’s national HIV treatment programme is looking to fix. The latest UNAIDS projections for South Africa say that 2.2 million people are receiving antiretrovirals, but national figures have been unable to track retention in care or the quality of care.

To remedy this, National Department of Health Deputy Director General Yogan Pillay has proposed the introduction of unique patient identification numbers to allow the Department of Health to track patients over time.

From April, the departments of health and home affairs were evaluating how to use South African identification numbers as a basis for the system while still accommodating the estimated 30 percent of public sector patients that are non-South Africans. The proposed move comes just as the Department of Health has completed its norms and standards for e-health, or the use of information technology for health within the public sector.

“We have about 3 370 computers that are currently being installed in 700 health facilities,” said Director-General of Health Precious Matsoso recently. “We will be scaling this up across the country so we can have data sets for every person who presents in our facilities.”

Discovery is also beginning to put a greater focus on tracking outcomes – and feeding these back to facilities. In 2008, the medical aid launched a voluntary programme for kidney and dialysis centres to submit their outcomes to Discovery in exchange for Discovery’s detailed analysis and feedback.

According to Broomberg, Discovery saw an almost five percent improvement in dialysis outcomes among its members.

The medical aid also plans to make better outcomes worth more financially to the doctors it contracts by introducing quality measures into payment schemes.

“Paying suppliers of services for volume and not good outcomes – that structure is creating and aggravating wide variation in quality of care,” he said. “We’ll say to doctors, ‘we’ll pay you more for better outcomes’.” – Health-e News Service.

About the author

Laura Lopez Gonzalez

Laura Lopez Gonzalez was the Print Editor of Health-e News Service.

1 Comment

  • Well, it happened to my daughter at Lesedi Clinic, member of Clinix.

    My daughter suffered burns after she kicked a hot water bucket and fell on top of it. We rushed her to the hospital which is just few meters away from the famous Chris Hani Baragwanath Hospital. It was around 11pm sunday when we arrived. Nurses attended her and I had to go back fetch my medical aid card for the file to be opened.

    When I came back my partner was holding her and I was told they are done with her we can go home, I thought they were going to admit her or otherwise explain to us how serious is the burns. Instead we were told to come back the following day as early as 7 am.

    I thought we will meet with the doctor who will explain to us how deep is the burns, but no!!!! another nurse and just the changing of bandages within 12 hours.

    I was worried about the way they operated, on top of that they gave us a set of bandages and medicine to bring it back for the next change of bandages, why do we have to take it home????!

    I then told my partner I’m taking her to another hospital immediately but she refused and I took her word. The following day was Tuesday and the bandages were falling off and the medication they applied looked like cooking oil on the burn wounds. I quickly took my daughter to the Netcare Garden City where she was admitted for the whole week and wounds started drying up the same day. Two doctors examined her in front of us and told us the wounds will not be permanent and we can expect her to heal within a week.

    I was happy and I saw value for money. I have no words for Lesedi Hospital, but I believe they are motivated by Bara since they are neighbours