Authors: S Ranchod, B Childs, M Abraham AND R Taylor

Abstract: We benchmark the hospital-inpatient admission rates and average length of stay of the South African medical scheme population against a set of international comparators. Such a comparison is useful in developing reasonable expectations of the utilisation achievable in the private-hospital sector in South Africa, and as a means of identifying unusual characteristics of the South African environment. Such comparisons should be done on a like-for-like basis, and explicitly adjusted for differences in data definitions, patient demographics and clinical case mix. Structural differences between countries must be considered in interpreting results. We use an economic basis for determining the comparator set rather than a health-systems basis. Detailed case-mix data by country is not available so demographic and broad disease-grouping categories are used as proxies. A further limitation is that day cases are excluded. Considering two separate data sources, South Africa appears to have relatively high admission rates with low average lengths of stay. On a combined basis, the bed days used per 1 000 medical scheme beneficiaries for South Africa appears near the lower end of the spectrum, which suggests that the South African private sector is making relatively efficient use of its hospital resources.

Keywords: Medical scheme; hospital; admission rates; length of stay