Only thirty percent of South Africa’s doctors work in the public health sector, serving more than 84% percent of the population – well over 40 million people, according to a 2014 special report in The New England Journal of Medicine. And that scenario is likely to worsen as many provincial health departments – the implementers of health policy – are employing austerity measures as they struggle with rising costs and mounting debt.
But in many respects South Africa’s well-resourced, yet fragmented private healthcare sector, can learn from the public health sector’s integration efforts. About 16% of South Africans have private health insurance which provides them with access to 70% of the country’s doctors, according to The New England Journal of Medicine.
“In a well-functioning academic or public hospital the medical team [the different specialists and therapists] of a patient will meet regularly to discuss a joint treatment plan for that patient. But in the private sector doctors rarely work in a multidisciplinary team,” says Jonathan Broomberg, CEO of Discovery Health, the administrator of the country’s largest medical aid scheme, Discovery Health Medical Scheme. “This often leads to lower quality care and higher cost of treatment – partly, because of waste, such as the same investigations being performed multiple times by different doctors who aren’t communicating, or medical errors, which are made because doctors don’t have access to each other’s information.”
For example, “Polypharmacy” – when different doctors have prescribed multiple medicines to a patient, drugs that may work against each other – is one the most frequent outcomes of uncoordinated efforts. “We for instance have many elderly members, who suffer from multiple conditions, who are on five to ten different medications of which the one maybe exaggerating the effects. Dizziness, which lead to falls, is a one of the most common complications,” says Broomberg.
Numerous studies have shown that the frequency of hip fractures among the elderly can be reduced significantly when drug prescriptions are coordinated to prevent dizziness.
For Discovery Health this has yielded results: there has been 60% improvement in the “physical functioning” of elderly people who are members of the senior care co-ordination programme, which was started in 2013. The “cognitive functioning” of members has improved by 55% and the burden on caregivers has been reduced by 65%. Moreover, there have been 57% fewer preventable hospital admissions.
Ideally, health integration in South Africa should bridge the gap between the under-resourced public and wealthy private sector. But the country’s National Health Insurance scheme, which aims to do this, is moving slowly and is riddled with infrastructure and coordination problems.
The private sector has theatres and expensive diagnostic equipment, which are rarely used at night. It has well established electronic billing and health record systems from which the public sector can benefit.
But sharing between these two sectors is rare. Why?
“Rather than it being a technology problem, it’s a problem of political will,” Broomberg argues. “Does the leadership in the government and public healthcare system, and the leadership in the private healthcare industry, see enough benefit in working much more closely together? That’s the main obstacle.”
The solutions are there. But are they wanted by the role players involved?