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
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.