Concern over medical aid’s new ruling

Doctors have expressed concern at a new rule introduced by Discovery medical aid in 2019 that some of its members have to use day clinics for certain procedures.

Members of the Discovery Saver, Smart, Keycare, Core and Priority plans have to use day hospitals or pay hefty co-payments to go to an ordinary hospital.

Discovery CEO Jonathan Broomberg said in an e-mail: “In the US, for example, up to 90% of all surgical procedures are performed on a same-day basis, whereas the equivalent figure in SA is below 15%.

“South African private health care is lagging well behind global trends in moving surgery to more cost-effective settings.”

But local doctors say the health care system here cannot be compared to the US.

The main concerns about day hospitals are that patients cannot be monitored overnight after procedures, the day hospitals do not have intensive care units, and many are not equipped to do blood transfusions.

Doctors say they were not consulted before the decision was made, while many of the day hospitals are not up to the appropriate standard to ensure operations take place safely, or have the equipment needed.

A Facebook post by paediatric pulmonologist Fiona Kritizinger, which has been widely circulated among doctors on WhatsApp, drives the point home.

“We do airway endoscopies on babies and children because their airway is at risk or because they have significant lung disease,” she wrote.

“Performing such high-risk procedures on babies and children in a facility with no aftercare and no ICU back-up will never be safe, no matter how Discovery spins this story regarding what happens in other countries.”

She said there was not a single day hospital in the Western Cape with equipment to perform surgeries Discovery wanted to be done in day hospitals.

In response, Discovery’s Broomberg said doctors could ask for exceptions to be made in these cases.

Specialist physician Adri Kok said there was a real risk that complications from surgery could not be dealt with by a day hospital.

“What if a child has a tonsillectomy and bleeds to death? This happened last year in a day hospital,” Kok said.

Broomberg said doctors could apply for exemptions if they needed to perform surgery on a patient in an acute hospital owing to the risks.