As is well known, there is a world-wide trend - and South Africa has not escaped this - for medical costs to escalate at an ever-increasing rate. All funders and providers are seeking ways to evaluate, manage and reduce the costs but without reducing quality of care. If anything the aim of the provider is to offer a more efficient and more effective system of health care on an outcomes-based model.
Funders, in an attempt to reduce costs, have reduced spending on all areas they feel are "luxuries". Regrettably, physiotherapy and occupational therapy have fallen into this group.
- For many years therapists have been given sub-inflationary fee and salary increases both in the public and private sectors. This has reduced profitability and therefore viability of private practices and made running hospital departments much more difficult.
- Medical Aid limits for therapists have been slashed and even removed totally particularly for outpatients.
- A number of risk-management and software companies are moving between the funder and the practitioner thereby reducing the funds to the therapists.
- Most members of the general public have little idea of the services offered by therapists and therefore do not make use of them.
- The same may be said of doctors particularly where doctors and therapists share the same fund allocation pool.
- Funders cannot measure and therefore put a value on therapeutic treatment.
- Both the general public and the medical profession, particularly in private practice, place a low value on physiotherapy and occupational therapy. The therapists themselves also tend to suffer from a low professional esteem.
- Those therapists in private practice are suffering increased payment time and bad debt.
How did we get in this mess?
Many factors have contributed despite the Herculean efforts of many people in the profession.
- Jealousy and competition between practices.
- Jealousy and competition between professions.
- Marketing of professions and practices limited by overly onerous codes of ethics.
- Lack of large scale research.
- Lack of data to back up negotiations with funders.
Therapists do have value
What do therapists do to save money and promote efficiency?
- Get patients out of hospital faster, saving bed fees.
- Get patients back to work faster, saving employers' money.
- Get people back to work, saving disability funds.
- Better rehabilitation improves function and reduces the burden of care and therefore its cost.
- In musculo-skeletal problems, manual therapies and rehabilitation treat the underlying cause and reduce if not remove the need for costly medication.
- By returning a person to full function, it reduces the financial burden for his dependants on the wider family and community.
- Therapists promote a healthy lifestyle preventing recurrences of injuries.
- Therapists are involved in injury prevention and health awareness programs in the work place and in the community.
It should be remembered that the skill and drive of the therapeutic team determine the length of time between surgery, injury or illness and full potential recovery and the degree of success achieved and thus the costs incurred.
RehabSA was formed in August 1999 to offer services to therapists that they could not perform themselves.
- To develop database software to collect data from assessment, treatment, rehabilitation and re-assessment on outcomes-based principles measuring a functional impairment score at the beginning and end of the process.
- To establish a national database for research.
- To set up an effective marketing strategy.
- To negotiate on a business to business basis with funders and risk managers.
- To offer legal advice.
- To offer practice management support.
- To provide a clinical help desk
- This software has been designed by South African therapists for South African therapists and follows the normal flow of assessment and treatment.
- It will be integrated with a billing package so that there will be no duplication of data input.
- The use of click boxes, wizards and look-up tables make the system quick and easy to use.
- It will be available in English and Afrikaans.
- It will reduce the time of data collection and add to a paper-free office.
- Practice data may be analysed on site.
- National norms for a specific diagnosis to establish best protocols.
- Use of ICD10 and CPT4 coding systems for diagnosis and treatment will allow us to compare our data with that from overseas.
- South Africa is not like Europe or the USA so our own set of norms per diagnosis and occupation have to be established.