Primary healthcare ignored in SA for far too long

Coordination of care must become a key focus in SA healthcare funding environment

Friday, 12 September 2014

It was a day of active debate at the Government Employees Medical Scheme (GEMS) Symposium in KwaZulu-Natal yesterday when the medical scheme, representatives from a major healthcare provider organisation and the Department of Health (DoH) participated in a think tank that is set to bring primary healthcare service providers to greater prominence in South Africa.
Opening the debate, Dr Stan Moloabi, Executive: Healthcare Management of GEMS, said indications were that the health of the nation was at an all-time low with lifestyle-related or non-communicable diseases approaching epidemic proportions. He added that the time had come for the wellness of the nation to become a key focus.
According to Dr Moloabi, the dire state of health of South Africans was first highlighted in a series of articles probing the health of the country published in The Lancet in August 2009. At the time the publication warned that the country was in the midst of a profound health transition characterised by a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders.

Adding to this, earlier this year the World Health Organization's South African office revealed in its country brief issued in June 2014 that approximately two out of five deaths in South Africa are attributable to non-communicable diseases (NCDs).
Noting the trends seen by GEMS in recent years, Dr Moloabi cited ‘doctor-hopping' as one of the key reasons for the poor state of health of medical scheme members. "A lack of coordination of care is costing GEMS, South Africa's largest closed medical scheme, as much as 5.7% more per annum. Patients who stay with the same healthcare provider are spending 2.9% less while those seeing specialists directly without being referred by a general practitioner are costing the Scheme as much as 9.4% more."
 
Referring back to his days as a healthcare practitioner, Dr Moloabi said that far too often the success of a healthcare practitioner was being measured by the number of patients seen per day as volume translates directly into revenue. "The inevitable reality of this is that medical schemes have become a bottomless payer. GEMS would like to change this so that doctors will instead be measured on the quality of their outcomes and be rewarded accordingly. We would like to see a move away from doctors treating episodes of illness to a situation where our healthcare professionals are actively driving wellness. Patients, in turn, must be channelled to doctors who offer better outcomes."

Dr Moloabi added that the delivery of healthcare must become fully integrated and coordinated at general practitioner level. In the process, new ways must be found to empower patients and members of medical schemes. "We need to enter an era of heightened healthcare consumerism with patients becoming the central focus of coordinated care."

Professor Morgan Chetty of IPA South Africa, a major healthcare provider network, added his voice to the need for a change in focus at primary healthcare level by stating that the country's healthcare professionals had to move from being passive to active providers of care. 

"Primary healthcare, which is the entry point for healthcare, has been ignored for too long in SA.  The burden of disease in our country is four times more than that elsewhere in the world and this is having a huge impact on medical schemes, their members and ultimately on the sustainability of the private healthcare system. For this reason, coordination of care must become a key focus," he asserted.

Prof Chetty said that the overall aim of the anticipated shift in focus is excellence through collaboration, adding that doctors needed to understand what medical schemes required and what their pressure areas were.

"The South African healthcare industry needs to move away from the concept of being patient centric to becoming population centric. In a patient-centric environment we wait for patients to become sick before we treat them. However, if we were to become more population centric we would actively monitor patients so that we could anticipate future healthcare problems and treat these proactively.  We need to promote value-based care and in the process create a consumer experience as part of our healthcare service," he said.

"In order to drive long-term gains in healthcare, it has become more important than ever that we do what is right for the patient. This means that outcomes and quality must be carefully measured and rewarded."

Talking of the future, Prof Chetty noted that the concept of ‘medical neighbourhoods', which were started in the United States of America along with ObamaCare, as one possible way forward. This concept spelt the end of primary care practitioners and specialists who function in silos and within boundaries. A typical medical neighborhood relies on flexibility, expertise and coordination of care, with patients experiencing a seamless transition between different providers of care in order to achieve the greatest possible benefit.

Ending on a high note, Moremi Nkosi, technical specialist for National Health Insurance (NHI) Policy at the DoH, concluded by stating that healthcare was a national asset, which is pivotal to the economic sustainability of South Africa.

"For this reason it is important that we keep people as healthy as possible for as long as possible and that we plan for when people get older and when their health deteriorates," he said.