PHC re-engineering may relieve overburdened tertiary hospitals in South Africa.
Under the National Health Insurance, a hospital is expected to provide service to patients based on its category. However, in reality the tertiary hospitals offer every level of care, resulting in poor quality of care and over-expenditure. The Polokwane/Mankweng Hospital Complex is a provincial tertiary hospital that delivers tertiary care as well as dealing with some secondary and primary care cases. This study evaluated the hospital casualty department in the Polokwane/Mankweng Hospital Complex. A sample of 250 patients' records was selected by simple random sampling from a cohort of 14 113 patients who attended the Polokwane Hospital Casualty Department during the 1-year study period. Most patients were admitted in the casualty department as a result of injuries (25%). Only 20% (N=51) of the patients were referred from other health facilities. Half of the patients could have been managed at a regional or district hospital. The overall expenditure for the casualty unit during the 1-year study period was R10  321 401.42 and the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs. Referral systems must be strengthened to manage patients at regional and district level to reduce the burden on the Polokwane/Mankweng Hospital Complex. It is hoped that the Primary Health Care (PHC) Re-engineering Policy will address this by strengthening the referral system in PHC facilities.
University of the Witwatersrand, Johannesburg, South Africa.
Morongwa Caroline
MC
Mohapi
Debashis
D
Basu
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013019:South Africa; D055815:Young Adult