Day hospitals – the smart hospital choice… or is there NO choice?

Procedures with minimally invasive surgical techniques are on the forefront – the future of healthcare is shifting towards a day hospital setting. This is common practice internationally, why then is South Africa so different?

In general, a hospital account consists of –

  • a hospital fee,
  • theatre fees,
  • consumables
  • and equipment fees.

If you compare a day ward fee in a day hospital with a larger acute hospital, the day hospital fee is lower. Theatre fees are billed per minute in theatre – once again, day hospitals are the cheaper option when compared to larger acute hospitals. Day hospitals, by nature surgically orientated, only offer theatre facilities and ward accommodation and are streamlined and do not have to make provision for highly specialised units and other medical services found in larger acute hospitals like trauma, ICU, maternity units etc.

Ten years ago, the difference in pricing between acute- and day hospitals were significantly greater. Growth in the day hospital industry over recent years has resulted in acute hospitals lowering their price on day procedures to remain competitive in the healthcare market. The question remains – if day hospitals close their doors what would happen to overall hospital costs in the industry? Without a doubt this will increase again which is exactly why the day hospital industry feels strongly that patients and funders have to support the day hospital concept and doctors should without a doubt secure theatre slots in both acute and day hospital settings. It is vital to the sustainability of the overall healthcare industry that day procedures are performed in the most cost-effective setting with careful consideration of patient suitability to the environment and the risks involved with any surgical procedure.

Day hospitals generate income by performing same day surgical procedures only. Medical schemes can provide data on day hospital procedure outcomes and the cost effectiveness of these procedures in comparison to the same service in larger acute hospitals.

The struggling economy will bring about changes in the South African healthcare landscape – patients will downgrade or cancel medical aid plans and then search for high quality patient care at a more affordable price, which day hospitals are able to provide.

What happened in the day hospital industry during the COVID-19 pandemic?
Not only day hospitals, but every hospital group in the healthcare industry showed a decline in elective surgery during the pandemic. If surgery had to be performed during this time, it was found that the day hospital industry attracted urgent surgeries to their smaller family-like facilities… While the larger acute hospitals, because of their nature, were able to fill their units and accommodate COVID-19 positive patients. Patients and surgeons alike felt more comfortable in day hospitals even more so during this time and the various efficiencies found in day hospitals are evident.

As things progress towards the new normal, specialists are caught between a rock and a hard place. Do they have a choice where they can operate or will they need to fill their theatre slots in the larger acute hospitals where they have consulting rooms? The situation for patients is similar. Do they have the option to consider day hospitals as an alternative setting for surgery? Or choose a day hospital because they feel more comfortable there?

Which makes us rethink the question…
Why is there such a slow uptake in day hospital surgeries in South Africa? Why is it that most day surgeries internationally are performed in a day hospital setting, but in South Africa most day surgeries take place in larger acute hospitals? Is it due to the funding models in South Africa? The HMI (Health Market Inquiry) explored some of the reasoning and it remains uncertain if the inquiry was merely an opinion and if the status quo in the healthcare industry will remain.

Day hospitals are smaller in size yet offers the exact same day procedures and lay-out as the larger hospital groups’ theatres. The success of a day hospital is to build collaborative and strategic relationships with doctors and all other stakeholders.

The medical aid industry is supportive of the day hospital surgery initiative. More and more medical aids are following Discovery Health in its objective to form a day hospital network for day procedures leaning towards appropriate procedures for appropriate patients in appropriate settings. Day hospitals remain the appropriate setting for day surgery where

patients have a faster same-day discharge time, on-time surgery slots and an extremely low risk of infection as no long stay medical patients are admitted.

Take a moment to consider the following…

If you had an elderly mom in need of an operation, what would be the most appropriate place for her to have surgery? A larger acute hospital with between 5-15 wards and 7 theatres or a smaller setting with personal care, limited bed capacity, only 2-3 theatres and the ability to provide appropriate care paying full attention to detail.

There could be many reasons for South African day hospitals lagging their international counterparts, but these reasons remain largely unknown. The fact however remains that internationally more day surgery procedures are performed in day hospitals than in larger acute hospitals.

Without a doubt, the shift will come – it is just taking longer than expected. Continuous medical and technological advances will create the opportunity for more complex procedures to be performed in day hospitals. The South African day hospital industry remain patient and will eventually grow to be more in line with international trends. Let’s take note of the progress in the day hospital industry over the next five years as independent day hospitals and other day hospital groups, passionate about day surgery and appropriate surgical patient care, are convinced of a substantial volume shift yet to come. Savings on the cost of healthcare should be high on the agenda for both medical schemes and patients. Day hospitals can provide such savings without a doubt!

Editorial content by –

Bibi Goss-Ross

Supported by –

The Day Hospital Association of South Africa