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DAILY DISPATCH 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, key-care, core and priority plans have to use day hospitals where patients can not stay overnight or pay hefty co-payments to go to an ordinary hospital. Discovery chief executive Jonathan Broomberg said in an e mail to Times Select: "In the US, for example, up to 90% of all surgical procedures are per formed on a same day basis, whereas the equivalent figure in South Africa 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 healthcare system here cannot be compared to the US. The main concerns about day hospitals are that patients can not 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. Wits University professor and ear, nose and throat ENT specialist Chris Joseph said: "Patients would feel abused and exposed to possible risk." He said Discovery did not assess whether the day hospitals had the correct equipment or staff for a procedure. "ENT theatre requires very expensive instruments and trained staff." Joseph said doctors had to observe patients who had surgery on their airways to en sure they did not have.com plications that compromised breathing. This means operations at a day hospital must be done in the morning so patients can be watched closely in the afternoon. "Many ENT day cases must be done in the mornings for patient safety. "Discovery did not check whether the day clinics have morning lists availability," Joseph said. 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 dis ease," 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. A day hospital does not always have the skilled resus citation staff or an ICU and may not have blood for transfusions, she said. Surgeon Stefaan Bouwer said equipment for ENT surgery cost up to R3m and some day hospitals could not afford this. However, Discovery said this was not true. "Day clinics are accredited in South Africa, and the procedures on the Day Surgery Network list are aligned with those of the Day Hospital Association of South Africa." Broomberg said: "Day surgery centres have been shown to be safer and more cost effective when operated efficiently. "The list of procedures that are performed in the Discovery Health medical scheme day surgery network has been approved by the Council for Medical Schemes." Joseph said: "Ear, nose and throat societies are not opposed to day clinics. We use many currently. But we need to en sure that the day clinic can deliver on quality care. "The Discovery modus operandi is to expose patients to risk and or poorer quality and rely on specialists to correct this by checking the day clinics' services and facilities." Joseph said ENT doctors were now checking every day clinic that had to be used to ensure they met safety standards. Broomberg said it was adjusting its approved hospital list in consultation with doctors. But Kok said SA could not be compared to the US where most operations took place in day hospitals. She said the US had better medical support at day hospitals and more doctors to travel between day and acute hospitals. Kok said she was a medico legal witness in 2018, in a case of a patient who had a hysterectomy at a day clinic. The patient began to bleed internally and the gynaecologist did not pick up the internal bleeding in time. By the time the doctor realised it, the day clinic did not have blood for a transfusion. The patient almost died. Broomberg said doctors could apply for exemptions if they needed to perform surgery on a patient in an acute hospital owing to the risks.
Created at 2019/02/19 01:24 PM by Mediclinic
Last modified at 2019/02/19 01:24 PM by Mediclinic