ISQUA16-2820NARROWING THE GAP: HOSPITAL ACCREDITATION AND INEQUALITY IN SOUTH AFRICA

Abstract

Objectives: To identify differentials in aspects of performance (as measured by the various accreditation components) and quality, as measured by health outcomes, between the public and private sectors in South Africa. The South African health system is characterised by high levels of inequality; both in the quality of care provided and in the ability for different subsets of the population to access this care. The most notable differential is between the public and private healthcare sectors in South Africa. Private healthcare in South Africa is generally perceived to offer higher and more consistent quality of care, albeit at a price. The sector accounts for half of national health expenditure but access is limited to those who can afford private care: the 16% of the population with private cover and the minority who pay out of pocket. Despite comparably high healthcare expenditures overall, these inequities result in relatively poor outcomes. Of particular concern are poor outcomes for maternal and child mortality. Health reforms in South Africa are aimed at reducing the extent of these inequalities, with strong emphasis on improving the quality of care in the public sector. The public sector is described as having "quality problems in the areas of staff attitudes, waiting times, cleanliness, drug stock outs, infection control and safety, and security of staff and patients". Methods: With the assistance of COHSASA (The Council for Health Services Accreditation of Southern Africa), it has been possible to compile a unique data set that includes valuable information on both public and private hospitals in South Africa. COHSASA conducts comprehensive quality accreditation surveys for hospitals across Southern Africa. This has allowed for the analysis of the two sectors according to a common yardstick. The data includes accreditation scores and situational analyses for 178 hospitals over the period 2006-2015. The COHSASA data were linked to both census (2010) data and health outcomes data. The link to census data allows regional variations in quality of care to be explored. Of particular interest is the question of quality of care in rural and poor regions of South Africa (i.e. for the most vulnerable segments of society). By linking to outcomes data we are able to explore the relationship between accreditation scores and outcomes. This in turn allows for the differentials in accreditation scores between public and private hospitals to be meaningfully related to differentials in health outcomes. Results: The polarisation between the quality of public and private facilities is evident from the accreditation data. Private facilities consistently score above public facilities across a range of accreditation categories, and there is far greater variability in the scores achieved by public facilities. The impact of the level of inequality in the provision of healthcare in South Africa, and the areas where these inequalities are most severely experienced, can be clearly seen. Conclusion: This research informs policy makers where to concentrate improvement efforts. This will help inform attempts to improve access to quality healthcare in South Africa. The level of insight that a study of this nature can provide is encouraging, and can pave the road to making much needed progress in improving the currently flawed South African health system.