Reviewing the findings of the 2015 Health Quality Assessment 2015, Dr Johann van Zyl of Towers Watson’s short answer to the question was ‘no’. This is despite some encouraging trends in certain areas and an increasingly robust data set accumulated over five years, embracing approximately 77% of covered beneficiaries across 18 schemes, nine administrators and 168 health quality indicators. “So much more is still possible,” he told delegates at the 16th annual conference of the Board of Healthcare Funders. “Whether the improvements in quality of care that we have observed translate into true value, given the dramatic increases in both contributions and claims, is also open to debate,” he said.

Despite positive trends with regard to maternal and child health measures and primary care in general, the downward trend with regard to chronic diseases is a significant cause for concern. He cited both respiratory conditions and diabetes in this regard, noting that there is a low uptake of early basic interventions like an influenza vaccination for the former and regular glucose and lipid monitoring for the latter. The results of this are higher hospitalisation rates and higher costs.

In contrast, HIV management shows remarkably good results, with well above 90% of patients registered for chronic ARV therapy and decreasing hospital admission rates further thereto.

He concluded that a better understanding of outcomes relative to return on investment is necessary, especially with regard to the current hospicentric scenario with its rampant annual inflation. Benefit design alone cannot account for variations in quality observed. “What’s really needed is a focus on learning from each other. What are the schemes with better results doing right? And what lessons from the HIV approach can we transpose to ensure better management of other chronic diseases. We need to standardise the data universally available to us and identify a causal link between process and outcomes indicators,” he said.

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