If you belong to a medical aid…
SA Home Care is contracted to most major medical administrators
Patients who belong to medical schemes managed by these administrators will require pre-authorisation by the medical administrators and therefore these patients will NOT be required to pay any fees guaranteed by the pre-authorisations.
As when being admitted to a private hospital, patients will none-the-less be required to sign a letter of guarantee to cover any shortfall that may arise.
Benefits Provided to Medical Schemes
Multidisciplinary homecare services, most particularly in lieu of hospitalisation and funded out of risk benefit, are able to provide benefits to the medical scheme via:
• Reduced length of stay and on average 35% reduced healthcare costs, as compared to in hospital care.
• Attraction of new members who would prefer homecare options, as most people don’t like hospitals and prefer the dignity, privacy and familiarity of their own
SA Home Care is well placed to:
• Advise medical administrators on how to unlock value for schemes and members.
• Provide protocol and guideline driven, coordinated homecare services in lieu of hospitalisation.
There are numerous international studies to show the rationale and economic logic for offering willing members the option of homecare in lieu of prolonged hospitalisation.
A study conducted in Thailand (Journal of Medical Association of Thailand, 2004, March, Volume 97, Supplement 13) investigated causes of prolonged hospitalisations in medical wards, and findings included the following:
• At day 7, 20% of patients on hospital were stable but awaiting completion of intravenous antibiotics
• At day 14, 16% of patients in hospital were stable but were awaiting completion of intravenous antibiotics
• At day 30, 18% of patients in hospital were ventilator dependent, and a further 15% were in hospital because of dificulties in finding appropriate carers for home
• At day 90, 30% of patients in hospital were receiving palliative care (end of life) and a further 30% were in hospital because of dificulties in finding appropriate
carers for homecare.
• After 90 days, 80% of patients were receiving palliative care (end of life)
The above study demonstrate the great number of stable patients who are in hospital for intravenous antibiotics, and who being stable could receive such care at
A study (Van Niekerk, L and Raubenheimer, PJ: South African Medical Journal 2014, April, Volume 2, 138-141) conducted in Cape Town during November 2011 and January and February 2012, reviewed note of about 1, 500 patients in 11 government hospitals, and deduced from the medical notes that 16.6% of all patients were in fact receiving palliative care (end of life care).
Palliative care was defined as patients who were not expected to live more than 12 months, and who were suffering from one of these end stage conditions: end stage cardiac failure, renal failure, lung disease, stroke, cancer, AIDS, intracranial bleed unfit for surgery, or were post cardiac arrest.
The above studies also demonstrate the great number of patients receiving palliative care in hospital. The majority could receive care at home. Indeed, palliative care patients want to be cared for during those lasts weeks and months in the comfort and dignity of their own homes. This is clearly demonstrated by review of a data base of 58 studies involving 13 countries and one and a half million patients: the majority wanted to be cared for at home, most especially when functional status was low, home care services were available and intense, patients were living with relatives, and patients wished to be at home (Gomes, B and Higginson, IJ 2006: British Medical Journal, 332515-521).
Further, international studies (2001 to current) have documented compelling evidence as to the economics of homecare in lieu of hospitalisation.
Hospital in the home is 38% cheaper than in-hospital care. (Macintyre, CR et al. 2002. International Journal for Quality in Healthcare 14; 4; 285 – 239 )
Palliative home care teams, as opposed to care provided in hospital outpatient clinics, reduce hospitalisation by about 10% and emergency room admissions by 8%. (Seow, H et al. 2014. British Medical Journal. 384.)
Palliative home care teams reduce costs by 33.3% compared to costs of in hospital care (Serrata, RS et al. 2001. Journal of Telemedicine and Telecare. 7; 226 – 232.)
Coordinated, managed home care reduce hospitalisations by a third over a five year period. (Shaughnessy, PW et al. 2002. Journal of American Geriatrics Society 50: 1354 – 64)
Community Mental Health Teams, treating psychiatric patients in the community in lieu of hospitalisation, reduce healthcare costs by 31% whilst clinical outcomes remain similar. (Burns, T. Beadsmoore, A. Ashok, VB. 1993. British Journal of Psychiatry. 163; 49-54.)
If you are a Private Patient…
SA Home Care will charge you medical scheme rates and not higher private rates
Patients who are private or where their medical schemes are contracted to SA Home Care but where pre-authorisation is not timeously received will be required to pay:
- The Initial Assessment fee prior to the Initial Assessment
- The fee for care, as per agreed upon Care Plan, weekly in advance of care
These payments may be made via credit card or EFT.
Fees for Consulting Services
Fees for Consulting Services rendered to Medical Administrators, Medical Schemes and to Patient Advocates depend on the nature and extent of the consulting activities, and are agreed upon prior to the onset of the consulting process.
Payment may involve one of three mechanisms:
- Monthly retainer – for Case Manager Formal Training and Discussion Groups
- Fee for service – for Case Management Advice on complex patients
- Capitation fee – for Disease Management