Accounting for the 'kill rate'

About 15 years ago I broke a story in the Mail & Guardian that has never been cleared up satisfactorily.

Several babies in the neo-natal intensive care unit of the Park Lane Clinic had died from a bacterial infection. Bacteria had been found in the drip bags attached to the babies, and in the babies’ bodies.

The Park Lane Clinic is a private hospital that, at the time, belonged to Clinic Holdings.
Clinic Holdings has since become Netcare. The same bacterium killed dozens more babies in several outbreaks, one as recently as this year.

The hospital, other hospitals, doctors, nurses, and all other professionals along the way were blameless, according to various inquests into the deaths. Only an employee of the drip-bag manufacturing company, who allegedly had “dirty cuffs”, was held to blame. Huge shortcomings were obvious in the regulation of private hospitals but, in reality, hardly anything was done.

In the more recent event, “drip bag watchers” will have noted that blame was similarly apportioned. The drip bag company’s name was not mentioned and the controversy all seems to have gone away — again.

There is now talk of regulating private hospitals to keep costs in check. This would be a good opportunity to look at a few other issues concerning private hospitals.

The following is a wish list for patients in the private health sector — more specifically medical scheme members who pay for it all.

It is in the interest of scheme members, and employers who subsidise employees on schemes, to know that the hospital they use and the doctors attached to it provide quality healthcare — without unnecesarily risking the lives of patients.

There is a major risk of acquiring infections in hospital, of mistakes in the delivery of treatment and of substandard care by health professionals. Ultimately, there is a risk of death from any of these shortcomings.

Knowing which hospitals have higher infection rates and placing patients in those with low rates will raise the standards of those lagging behind.

Such measures exist in the United States, while a number of large corporations use the data to ensure quality health outcomes for employees they insure for health coverage.

Medical schemes already have most of the information available, and the larger schemes and administrators, such as Discovery Health, Medscheme and Mx Health, probably cover most private hospitals.

In some states in the US, patients can ascertain how many people a particular surgeon has “lost” as a result of surgery. Certain doctors have higher “kill rates” than others.

Medical schemes tend to dwell on what doctors charge. It is not a part of the conversation that certain doctors appear to have larger death rates; or that their patients tend to be readmitted to hospitals more often than others. But these facts are available — whether or not it makes use of them is up to the scheme.

Errors are also made in prescribing, dispensing and medicating patients in hospital. Much of this information can be picked up by schemes that pay for the correction of errors.

Then there are hospital-acquired infections. Hospitals have to keep data on these infections, but a reporting mechanism is not in place.

Patients ought to want full disclosure. It ought to be mandatory for such statistics to be accessible to the public. Patients should ask medical schemes whether they are being steered under agreements to hospitals that perform less well than others.

Doctors who charge too much, in a scheme’s opinion, are subjected to pressure. They should also be squeezed over how many patients they may have made ill, or even killed, that year.

This, as I said, is a wish list. But it would be very nice if Father Christmas could be induced this year to incorporate these and other quality outcome markers into the proper regulation of private hospitals.

Pat Sidley is head of communication and education at the Medical Schemes Council

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