The not-for-profit Health Quality Assessment (HQA) last week released its 17th annual industry report on the quality of healthcare in South Africa. Data from 18 medical schemes, representing 91 benefit options and 78.7% of all insured beneficiaries (7.02 million), were used for the annual analysis of 174 health quality indicators.
In this year’s data analysis, based on 2020 claims data, the profile of the population reflects 46.3% males and 53.7% females and an average age of 34.4 years, up 2.38 years over the past 10 years. Of the top three most common chronic diseases the data shows a prevalence of 11.2% beneficiaries with hypertension, 4.3% with diabetes and 3.6% with asthma. 23% of beneficiaries have at least one chronic condition and 9.8% have more than one chronic condition.
One of the categories of HQA’s annual analysis is prevention and screening. Although there appears to be a steady improvement in indicator measures year to year, the results do not compare favourably with international benchmarks. Of the at-risk population in South Africa, only 20.4% of women went for a mammogram (67% internationally) in the previous two years.
Coverage for cervical cytology in South Africa is 31.4% for a pap smear in the previous three years, compared with 70% internationally. Screening for colorectal cancer, via colonoscopy, was undertaken in 9.8% of lives compared with a 56% internationally, and flu vaccines uptake in the over 65s was just 16% compared with 44% internationally.
In 2020, hospital admissions were lower with 10.91% of all beneficiaries admitted, down from 15.4% in 2019: 2.54% beneficiaries were admitted more than once, down from 3.8% in 2019. There was a percentage of 9.65% of beneficiaries with no chronic condition who were admitted, down from 14.6% in 2019, and 15.1% of beneficiaries with a chronic condition were admitted, down from 17.6% in 2019. The downward trend of admissions in 2020 can be ascribed to the reduction of scheduled procedures due to COVID-19 related reasons.
The pandemic resulted in hospital capacity becoming under pressure and the COVID-19 negative population reluctant to seek hospital care. It is noteworthy that the admissions during the pandemic for beneficiaries with a chronic condition remained relatively high, compared with admissions for beneficiaries with no chronic conditions.
In summary, there was a lower patient/doctor engagement in 2020 than in previous years. The highest quality scores were achieved where a general practitioner and a specialist were involved with the same patient.
There was a reduction in hospital admissions with an increased length of stay. Admissions for beneficiaries with no chronic conditions or with better-managed chronic conditions were lower than those with poorly managed chronic conditions. In 2020, 106 out of every 1000 beneficiaries (2019: 135.2/1000) were admitted at least once and 25.4 out of 1000 beneficiaries (2019: 34.9/1000) were admitted more than once.
The HQA analysis revealed a pattern of health-seeking behaviour that could be economically driven. There is a constant trend of medical scheme members opting for more affordable benefit options, resulting in reduced access to healthcare. A continuation of this trend might have a negative impact on the quality of healthcare.
This should not be interpreted as if the more affordable options do not offer benefits for sicker beneficiaries. All of the chronic diseases analysed in the HQA Report appear on the Chronic Disease List (CDL) and most of the healthcare services represented by the process measures pertaining to chronic disease management should form part of Prescribed Minimum Benefits (PMBs).
The lower scores in prevention and screening and chronic disease management than in previous years could have a negative impact on the burden of disease and the development of co-morbidities and complications and should be monitored. The lower utilisation of hospitals for elective procedures during the period of the pandemic may lead to a sharp upward trend once the pandemic has ended.
HQA’s results should be interpreted with caution as there is a multitude of reasons why a specific quality indicator could be performing well, or not well. The Healthcare System is complex and there are many aspects of it that contribute to the quality of the healthcare patients receive. What is important is that the results are shared with the HQA participants and stakeholders and used for continuous improvement.
Issued by HQA