Neighbourhood doctor the key to healthcare costs
YOU hear it like a broken record on every platform discussing medical aids, hospitals and costs across South Africa: medical costs are out of control and must be brought down.
It is almost an irrelevant statement because no one, obviously, disagrees with that sentiment.
But the real issue, like many of our challenges in South Africa, is how to do it.
Based on our experience of running one of the biggest medical aids in the country, it seems there is one central way to attack these costs directly — improve the skills of doctors and practitioners.
This means patients will get better-quality care, costs will go down and they will get more immediate relief.
It is clear where the costs are coming from in the system.
The latest Council for Medical Schemes report shows that hospitals and specialist services are the primary cost drivers.
The payments for hospital services accounted for 36.7% of the total benefits paid to healthcare providers during 2012, whereas specialist fees accounted for a further 23.3%.
Together, payments to hospitals and specialists accounted for 60% of the total paid to providers — and the especially worrying part is that these costs are escalating at a rate of between 11% and 12% annually.
Drilling down further, using our own data at Bonitas, shows that a large proportion of our hospital costs result from overnight admissions.
In particular, admissions for pneumonia and gastroenteritis feature in our scheme’s top five admission categories and represent the top cost drivers.
This is an apt example of the point. You could avoid admitting people to hospital for this by educating general practitioners on clinical guidelines and giving them clear instructions on how to manage these conditions in outpatients.
Equally, if we provide GPs with greater skills, they would be equipped to perform relatively minor procedures in their rooms rather than referring them to specialists and hospitals.
All medical aids are trying to respond to this issue as best they can. We at Bonitas have established a programme designed to enhance the surgical and medical skills likely to be needed by GPs. The ultimate objective is to increase the GPs’ ability to manage patients more appropriately at a primary care level to reduce the pressure on the already overburdened secondary care level.
In practice, this means that GPs who use this programme are rewarded for managing clinical and surgical conditions that are contributing to the escalating costs.
When the National Health Insurance scheme takes off in the next few years, this and similar schemes will be invaluable to keep a lid on costs.
In a country like ours, which is not rich yet faces sharply escalating health costs, we need to encourage behaviour change to keep costs in check while ensuring the right quality and clinical outcomes.
The neighbourhood doctor, who typically has the best relationship with the patient, is the key to whether South Africa can do this effectively. If we cannot form such a partnership, nobody wins — not the doctors, not the medical aids and certainly not the patient.
Ramasia is a principal officer of Bonitas Medical Fund