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Sub-Acute and Rehabilitation Care:
A Vital Step in the Journey to Recovery
South Africa faces a significant imbalance in the provision of healthcare facilities, with an oversupply of acute care and high-technology hospital beds compared to sub-acute or nursing home beds. This disparity, identified over two decades ago, has not changed[1]. While South Africa has a ratio of sub-acute beds to acute beds of 0.03:1, the USA boasts a contrasting ratio of 1.8:1. Although these figures date back to 2008, improvements have been minimal due to technological advancements driving acute care admissions and competitive pressures in the private sector[2].
The financial model in acute care facilities also discourages transferring patients to sub-acute facilities unless acute beds are in short supply. Occupied acute beds generate revenue, creating a financial disincentive to transition patients to lower levels of care. Until funding structures evolve to incentivise appropriate care levels, this imbalance will likely persist.
[1] Alex van den Heever 2001 National Treasury Report
[2] I Fourie, F Preller. The potential role of sub-acute hospitals and public-private partnerships in the South African private health sector. July 2008 BHF Conference
The Benefits of Sub-Acute and Rehabilitation Care
Global evidence highlights the value of sub-acute and rehabilitation care as a cost-effective and clinically appropriate alternative to prolonged acute care admissions[1]. South African studies echo these findings, emphasising the importance of matching the level of care to the patient’s condition[2]. Properly administered sub-acute care can significantly reduce healthcare costs by preventing readmissions, which are 125% more expensive than initial admissions on average.
[1] Comparing the Cost of Delivering Hospital Services across the Public and Private Sectors in South Africa Research Commissioned By The Hospital Association of South Africa. Shivani Ramjee University of Cape Town October 2013
[2] Sikhumbuzo A. Mabunda, Leslie London, David Pienaar. An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa. Int J Health Policy Manag 2018, 7(2), 167–179
"Alarmingly, South Africa’s private sector experiences readmission rates as high as 30%, driven primarily by inadequate discharge planning and underutilisation of sub-acute facilities."
[South African Medical Schemes data in 2022 CMS report]
A multidisciplinary approach is critical for successful recovery and reducing readmissions. Sub-acute and rehabilitation facilities that employ comprehensive assessment and intervention strategies deliver better outcomes. These facilities are equipped with skilled teams of healthcare professionals to manage patient care effectively, ensuring the transition to home care is smooth and well-planned.
Challenges in the Current System
A study by South Africa's National Treasury identified systemic issues in the private healthcare sector, including cost inefficiencies driven by imbalanced care levels. According to Alex van den Heever’s 2001 report, private hospital groups function as “an effective cartel,” resisting shifts from fee-for-service billing to more cost-effective models. This entrenched system has seen little change over two decades, perpetuating the challenges in optimising healthcare delivery[1].
Recovery from acute medical events depends on numerous factors, including a patient’s pre-event health, age, and co-morbidities. Each patient’s journey is unique, and a standardised approach is ineffective. Multidisciplinary teams, patient engagement, and family support are essential for successful outcomes. Without these, patients risk entering a cycle of repeated admissions, often driven by financial constraints or the inability to manage out-of-hospital care.
The Role of Sub-Acute Care in Recovery
Sub-acute care, including step-down and rehabilitation services, offers a structured inpatient program followed by home-based care where appropriate. These programs focus on mobilisation, recovery, and restoring independence or achieving optimal functioning, tailored to the patient’s condition and age.
Senso Health exemplifies comprehensive sub-acute and rehabilitation care. Its multidisciplinary team includes doctors, physiotherapists, occupational therapists, dietitians, speech therapists, social workers, nurses, and caregivers. This team collaborates closely with referring clinicians to deliver patient-centric care, while social workers play a pivotal role in supporting families and planning smooth transitions to home care.
The duration of sub-acute care varies based on the patient’s condition, from post-trauma recovery to palliative care for oncology patients. Senso Health employs dedicated case managers who work with medical schemes to ensure that treatment plans and expected outcomes are understood and approved, even when schemes rely on rigid approval criteria.
Why Choose Senso Health?
Senso Health prioritises patient-centred care, which translates into better outcomes and lower readmission rates. By addressing the unique needs of each patient, from stroke rehabilitation to advanced palliative care, the dedicated Senso Health team ensures appropriate care planning and effective discharge management.
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1 Alex van den Heever 2001 National Treasury Report
2 I Fourie, F Preller. The potential role of sub-acute hospitals and public-private partnerships in the South African private health sector. July 2008 BHF Conference
3 Comparing the Cost of Delivering Hospital Services across the Public and Private Sectors in South Africa Research Commissioned By The Hospital Association of South Africa. Shivani Ramjee University of Cape Town October 2013
4 Sikhumbuzo A. Mabunda, Leslie London, David Pienaar. An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa. Int J Health Policy Manag 2018, 7(2), 167–179