Exploring the ‘shift in place of care’ evident across the healthcare value chain

Have you ever had a surgical procedure performed at a day clinic?

Day clinics are becoming increasingly popular for planned, same-day procedures. This context is relevant to a wide range of surgical procedures – a list that is constantly being extended as safety and outcomes validate this. These days surgeons elect to operate in day surgery clinics for anything from ‘lumps and bumps’ (general surgical excisions and biopsies) to ophthalmic surgery, various ENT surgeries and some gynaecological, orthopaedic, gastrointestinal and urological procedures.

Trending: A ‘shift in place of care’

The shift in setting for these surgical procedures to ambulatory environments, like day surgery centres, represents a broader global trend in the ‘shift in place of care’. This shift was significantly accelerated through the Covid-19 pandemic’s impact on healthcare systems.

Day surgery centres offer convenient access to high-quality care, at lower cost. Another example of the shift in place of care includes the move from acute hospital admissions to treatment at home through hospital-at-home care - a trend that I have written about extensively in the recent past (for example, here ).

We also see doctor consultations shifting from face-to-face to telemedicine platforms. In diagnostics, central laboratory pathology testing is being displaced by point-of-care testing, performed at the bedside or in the doctor’s rooms for an immediate result, with high sensitivities and specificities (ensuring results are accurate), and this is also materially more affordable than traditional pathology tests.

By 2022, 33% of procedures on our DSN list were performed in a day clinic

In 2019 DHMS introduced a Day Surgery Network (DSN) into its benefits and by 2022 the DSN accommodated almost 1,000 different pre-defined surgical procedure types, across 74 clinical categories.

Discovery’s Health Intelligence team makes sense of significant amounts of health-related data and publishes insights on our Health Intelligence Hub. A recent analysis shows that by 2022, 33% of procedures on our DSN list were performed in a day clinic, up materially by 9 percentage points from 2019 when the DSN was launched. Patients' overall day clinic care satisfaction scores were up from 53% in 2015 to 82.7% in 2021. By comparison, private acute facility ratings among members increased from 50% to 64% for the same period.

We are enthused that the Discovery Health Medical Scheme benefits for day surgery facilities have supported the continued development of and also the improvement in these facilities across South Africa. We consider it a core responsibility to catalyse favourable disruptive healthcare trends that improve quality and lower cost.

All in all, the introduction of the DSN seems to have had multi-faceted benefits for Scheme members.

These benefits include improved convenience for patients, who also perceive the service they have received favourably (as mentioned above). Healthcare quality is just as good, with no deterioration in outcomes. And, safety seems also to be improved relative to acute hospitals. For example, our data demonstrate a lower risk of hospital-acquired infections, which stands to reason outside of large acute hospitals. Importantly access to day clinic care also means lower costs for the healthcare system, which benefits all members who contribute to medical schemes.

Read the full analysis on our Discovery Health Insights Hub: https://discv.co/3sIjT5Q

Thank you to Head of the Health Intelligence team, Shirley Collie , and the team on this research: Lara Wayburne Mann , Callan Kotzen , Chanie Suttner , Michael Cohen , and Lizelle Steenkamp .

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