Business & Economy

Monday, 06 July 2009 13:23

Doctor’s strike one aspect of strain buckling SA hospitals – technology needs to be used to help hos

{pp}dramatic shortages of specialists and 18 000 too few nurses

Technology and closer working relationships to leverage the private health sector’s skills are urgently needed to address growing challenges in public hospitals and to fund reform for the health sector.

It was recently reported that Gauteng hospitals owe food suppliers R50m. The Auditor General persistently expresses concern about hospital debt. In 2004, the Auditor-General found that Limpopo hospitals were owed R194m reflecting a 33% increase in patient debt, R33m of the R141,5m Free State debt was irrecoverable and Western Cape debt exceeded R444m. In Gauteng, the Auditor-General reported that R223,3m was owed. He said: ‘registers of patient files were not properly maintained. There were no controls or weak controls over patient billing. Dates of admission and discharge of patients were not always included in files. Patients were sometimes incorrectly classified in terms of income category, and billed for incorrect amounts. Medicines were not always charged to patients’ accounts.’

By 2007, Gauteng was owed R426m by patients with R156,7m owed to Johannesburg hospital alone, more recent figures are not available but are expected to be much higher. Luis da Silva, managing director of Healthbridge, South Africa’s largest health information exchange company said: “The largest cost in hospitals is for staff which comprise around two thirds of all expenditure (excluding pharmaceuticals). Staff costs have been increasing above the inflation rate since 2003 according to the Hospital Association of South Africa. And the Human Sciences Research Council estimates we will have a shortage of more than 18 000 nurses by 2011.” He said: “No machine can replace a good doctor or nurse, but technology can improve debt collection for hospitals, their ability to pay staff better wages and to buy better equipment to improve patient care.

In 2008, Healthbridge was able to ensure savings of R500m in the private health sector. We endorse the Minister of Health’s call for better public private partnerships.” President Jacob Zuma has expressed concern about falling health standards and Minister of Health Aaron Motsoaledi noted: “The World Health Organisation (WHO) recommends that developing countries spend at least 5% of their GDP on health. In South Africa we have far exceeded this recommendation - we are at 8.5% of the GDP. But our health outcomes are very unsatisfactory and rank among some of the worst in the world.” Motsoaledi cited as some reasons:

  • lack of management skills;
  • failure to act on identified deficiencies;
  • delayed response to quality improvement requirements;
  • poor technological management.

Motsoaledi said that his top priorities are “quality improvement for public health care facilities. Within the next year we shall start a plan towards the establishment of closer Public-Private-Partnerships in improving health facilities.” Da Silva suggested however, that PPP’s should also be used for skills training, technological advances, patient care and debt management. He said, “Healthbridge is looking at a number of innovative strategies to improve the mechanisms for payment, sharing of information and better patient care among all role players in the medical services industry.

Thus far we have focussed on the private sector but it is our belief that the lessons learned from the cost savings in this sector – and last year we helped medical aids and hospitals save more than R500m through increased efficiencies – could be as effectively implemented in the public health services sector.” He said some medical aids had noted that government hospitals claim for a small part of what they could for servicing private patients, “financial shortfalls are bedevilling what could be a great health system.” He said Healthbridge had been able to improve payment times in the private sector between patients, doctors, hospitals, pathology labs and radiologists from an average of 69 days in the past to 12 days now by using electronic payment and information systems. “We have eliminated patient waiting times to almost nothing by using pre-authorisation. There is no reason why our techniques could not work in the public sector.”

Da Silva said consideration also needed to be given to secure web-based sharing of patient information for easy coded access by doctors in hospitals. “We need to improve diagnosis and remove expensive needless tests. Patient memory is rarely reliable but in the United States as an example, details of more than a million people are now on a safe health information exchange, which enables electronic patient data to be shared among hospitals and physicians. “Nearly all of the hospitals and public clinics in places like Memphis participate. It allows emergency department doctors and authorized personnel to call up patients' blood tests, imaging scan reports and hospital discharge summaries.  The three-year-old exchange is helping doctors make better decisions and avoid wasting money on duplicating tests.”

Da Silva emphasised that skills training and technological advances could be shared by the private and public sectors in more efficient ways. “Too much is still being laboriously done by hand and best practices could radically improve the situation.” In former Finance Minister, Trevor Manuel’s budget 2009/10 he noted: “The rate of mortality in young adults has deteriorated, driven primarily by the HIV/Aids pandemic and tuberculosis. Infant and child mortality rates are also high.” The UN has noted with concern rising maternal mortality rates in SA. The 2009 budget made provision for the expansion of the hospital revitalisation programme. At present a total of 31 hospitals are under construction, 18 of which are due to be completed over the next three years.

Contact information:
Luis da Silva,
Managing director, Healthbridge
Tel: 011 581 1214
This email address is being protected from spambots. You need JavaScript enabled to view it.

Issued by:
Charlene Smith Communications Pty Ltd,
call 011 646 7637 or 021 762 2656

Contact: Leila Beltramo
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Tel: 021 762 2656

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