Article published in the MediBrief November 2016 issue:
Day Clinics
A more cost-effective alternative to hospitals for certain procedures
Value Care Plan members are already actively directed to the most cost-effective facilities on the Prime Cure network, including day clinics. Standard and Managed Care Plan members, so far, have not had the same guidance, which is why we would like to introduce the day clinic concept.
What are day clinics?
Day clinics are healthcare facilities that provide surgical services and allow you to have diagnostic procedures performed on a same-day basis, in an operating theatre, where you won’t have to stay the night. They offer convenient alternatives to overnight hospital stays.
Some day clinics are attached to hospitals and others are independent and not part of any hospital. For instance, some Medicross Clinics have independent theatres. These facilities will only admit patients for the day. Specialists will also perform endoscopies in some casualties.
Benefits of utilising day clinics for patients:
- Minimum disruption – procedure done on the same day, no overnight stay
- Day clinics provide a less traumatic surgical environment compared to a hospital
- The healthcare team that works with you does not change as there is only one shift, which makes it more personal experience
- There is a reduced risk of hospital-acquired infections
- Overall planning of procedures is more efficient compared to hospitals where emergencies will take priority. Day clinics plan admissions and procedures well in advance with fixed times and plan accordingly
- Patients benefit from a quicker turnaround time and speedier recovery
- Ease of admission and minimal forms to be completed
- Lower costs for the same procedures
From which benefit does the Scheme pay for day clinic procedures?
Standard and Managed Care Plans: costs for procedures at day clinics will be paid by the Scheme (from the risk benefit), at the Scheme Reimbursement Rate, or at cost if PMB – not from your out-of-hospital benefit or your MSA.
Avoid co-payments in hospitals and reduce costs for yourself and the Scheme
In the October MediBrief, we advised on different ways of managing the Scheme’s increasing healthcare costs and how the Scheme aims to save money for all members while funding high quality products and services.
In the past, the Scheme experienced unnecessary high hospitalisation costs for procedures that could have been performed in a more cost-effective setting, for instance, a day clinic or doctor’s rooms.
"When I went to hospital for a cataract operation, I had to stay overnight as the doctor could only see me the next morning."
– Member, 69 years old
"I didn’t even know you could go to a day clinic for these procedures." – Member, 72 years old
The Scheme, through Discovery Health, has negotiated competitive rates for day clinics and some other facilities for planned routine diagnostic gastroscopy, colonoscopy and other minor endoscopic procedures.
To promote the use of these cost-effective alternatives, a co-payment has been introduced which will only be charged if members have one of these procedures done in a hospital instead of a day clinic. This co-payment is R3 350. It is equal in rate to the difference between the hospital and the day clinic cost and is only applicable to members on the Standard and Managed Care Plans.
Emergency scopes, or scopes ordered if a patient has already been admitted for existing health concerns, will not be subject to a co-payment.
A similar co-payment structure has been introduced for cataract procedures where these procedures can be done in a day clinic. Find more information on page 37 and 69 of the benefit guide.
From January 2017, when obtaining your authorisation for these procedures, the Call Centre’s authorisation team will advise if there are co-payments due and guide you on how to avoid them. The team will also be able to let you know which day clinics are available near you for the procedure you need to have done.
How do I find day clinics close to me?
For more information and a list of day clinics near you, please call us on 0860 222 633. The member area on the website will also include a list of day clinics in the provider search. Please ask, when you make the appointment, whether the specialist that will be performing the procedure operates in a day clinic or from their rooms. Remember, a co-payment will apply if you are admitted to a hospital for a procedure that is not an emergency.
What happens in case of emergencies?
All emergencies will be paid in full, with no co-payment, regardless of where they are performed.