An Overview of Day Surgery and Day Hospitals

Annexure I

An overview of day surgery and day hospitals.

Day surgery, also referred to as same-day surgical interventions, is one of the fastest growing segments of the hospital industry in the world today.

Main reasons

Advances in technology such as keyhole surgery, the use of fibre optic light sources in theatres, computerisation of theatre equipment, the implementation of soundwave-based surgery and other advances in anaesthesiology are just a few of the developmentswhich stimulate the growth of day surgery.

Surgical procedures attended to in a day hospital can be executed more cost-effectively when compared to the same procedure attended to in a fully-fledged hospital.

International growth

International reports relating to same-day surgery state that in today’s surgical environment more than 75% of all surgical interventions can be attended to in a properly equipped and fitted out day hospital.

The International growth and utilisation of day surgery hospitals has been remarkable, as can be seen from Annexure I Slide A which is attached to illustrate the market penetration in the USA and Australia compared to South Africa. Unfortunately the growth in South Africa has been severely hampered. Some of the reasons for the stagnation of the day hospital industry in South Africa can shortly be summarised as follows:

• Closure of day hospitals by private hospitals in order to get these beds converted to more profitable hospital beds.
• Cost shifting negotiations with the aim to getting the more expensive hospital treatments, such as ICU services enhanced to enjoy higher fees while fees relating to short procedure surgery are decreased in order to make the utilisation of day surgery facilities less attractive.
• The day hospital industry has not been supported by medical schemes in order to make a meaningful difference to the private healthcare industry in South Africa.
• The Departments of Health do not see day hospitals as an alternative which could make a difference to the costs associated with private hospitalisation.
• Specialists who decide as to where theirpatients are treated often do not consider day surgery facilities as an alternative which can help to curtail private healthcare costs.

As a result of this stagnation, the industry in South Africa only catersfor 7% of the surgical interventions compared to a potential of 75% of all surgical interventions. Slide B of Annexure I has been attached to give a graphic illustration of this.

Examples of modern day surgery facilities

Facilities which have been developed over recent years in South Africa are modern and equipped with the latest technologically advanced equipment, as can be seen from some of the attached pictures. For further details please see Annexure I Slides C and D. Many of these facilities have been equipped to ensure comparability with private hospitals. The DHA is confident that some of its member facilities have been equipped to a level superior to the level found in many private hospitals in South Africa.

Extracts from the European Observatory of Health Systems.

Abbreviated extracts from the European Observatory of Health Systems and Policies,reflect the following statements, which the DHA believes should be seriously considered by South African Healthcare decision makers.

• Day surgery is now a high-quality, safe and cost-effective approach to surgical health care, enjoying a high rate of patient satisfaction.
• An understanding of the scope of day surgery is of critical importance for health policy makers.
• Day surgery, combined with new methods of imaging and near-patient testing, will allow many more procedures to be carried out in a primary care context.
• The expansion of day surgery entails a change in mind-set.
• Often, changes in national policies and regulations will be necessary, such as the removal of incentives that promote unnecessary hospital stays or obsolete professional demarcations. Once these changes have been put in place, itwill often be necessary to reorganize and/or re-designate existing structures, extend the roles of health professionals and other staff, explore ways of achieving better integration with primary care services to ensure optimal pre- and postoperative care, and develop appropriate financial and nonfinancial incentives.
• There are many advantages of day surgery over inpatient surgery for the health system, including an increased throughput of patients, improved surgery scheduling, reductions in staff and hospital costs, and a consequent decrease in waiting lists.
• Day surgery bears fewer risks of hospital-related infections, and patients can receive more individual attention when they are kept separate from seriously-ill patients in conventional inpatient wards. Complications arising after day surgery are usually minor, and mortality is extremely rare.

It should be noted that the European Observatory sees day surgery facilities as an important part of the delivery of healthcare services irrespective of these being of a private or public nature.

Day hospitals can add substantial value to the delivery of quality cost-effective healthcare services.

Over the past two to three years the medical scheme industry has expressed concern about the movement of members from the top of the range scheme options to middle and low cost alternatives. Many of the existing low cost alternatives offer very basic packages which include a form of hospital cover. Day hospitals are in a unique position to assist medical schemes with the recruitment of new members from the present employed but uninsured part of the population, in a cost effective manner. The employed but un-insured population is estimated at approximately 5 million. These employees and the members of their families are at present totally dependent on state services. With the help of the DHA suitably designed cost effective packages could be offered to this segment of the population. Such a step would help public facilities to move part of its healthcare responsibilities to the private sector. Again it should be noted that such a step can be made possible with the support of quality cost-effective services to be rendered by the DHA and its members. Annexure I Slide E is attached to illustrate the movement of patients from the high-cost alternatives to lower levels of cover.

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