South African Healthcare Experience

      Four days after arriving in South Africa I had developed a horrible cough and sore throat.  Thinking I had just picked up a bug during my travels, I took some over the counter medicine and fought my way through it.  That lasted about 3 days until one evening when I thought my fever was breaking I broke out the thermometer and I had a temp of 103.3.  Upon standing I became dizzy, my vision was blurry, I felt like I was going to pass out and I began vomiting.  Time to experience emergency room healthcare in South Africa.

      Luckily the day before this all occurred our friends who have been here for almost a year had shown us where a good hospital was so we knew where we were going.  Upon arriving in the Emergency Room they said it would be $60 to be seen.  We only waited a few minutes then the nurse took us back to a triage room for evaluation.  We were then lead into the main ER area and saw the doctor immediately.  The ER doctor figured I had a bacterial infection based on the labs that came back and my symptoms so she started me on two antibiotics in the ER.  5 hours later I was discharged after paying $200 for the IV medication and care and told to come back to the ER the following day for a follow up with the doctor.  I was also sent home with 5 prescriptions which we were able to fill for only $60 total and they were all American brands.  The ER doctor said to me when giving me the scripts, “there is a cheap pharmacy down the road, but that probably does not matter to you since you are American”.  I guess they think all Americans have plenty of money to spare, but little does she know I like a good deal.

      I felt much better the following day and expected to get good reviews from the ER doctor during my $30 follow-up but she said my labs were even worse and she was concerned.  Based on my symptoms she ordered a chest x-ray which cost me $54 in the Theatre (what Radiology is called in SA).  It was read immediately and showed that I had pneumonia.  The ER doctor said I needed to be admitted for treatment and asked about my medical aid (what insurance is called in SA).  I told her we had international insurance through Aetna and she said we needed to go to admitting.  Upon arriving at admitting they said since it was a national holiday for SA the insurance companies would be closed therefore there was no way to verify my insurance.  If I wanted to be admitted I would have to pay the required amount that they estimated for my inpatient hospital stay and they would have to find a doctor that would agree to admit me as a private pay patient.

      I was pretty concerned about the pneumonia and was willing to pay whatever was needed to get treatment.  I was pretty shocked when Admitting came back 5 minutes later and said I would need to pay $2,000 upfront for what they expected to be a 4 days hospital stay.  I had to hold back the laughter at the thought of getting such cheap care.  I said yes or course and then luckily there was a great doctor would who take me on as a private pay patient.  I asked Admitting what the options are for someone who can’t pay and they said, “you would have to find a hospital and a doctor that would take you”.  I thought the prices were possibly so cheap because of government assistance but Admitting said no, they don’t provide any free care here and everything has to be paid upfront.

      Next thing I know we are headed up to the Medical Ward.  The Main Sister (what a charge nurse is called in the US) said to me “Welcome, stay as long as you want”.  I guess the terms self pay has a totally different meaning in SA compared to the US where a patient would be hurried out of their hospital bed.  I noticed that all over my chart in big red letters was “PVT PT” meaning “private patient”.  Within 2 hours the admitting doctor was in to see me.  He was quite nice and very thorough.  At the end of the exam he said to the Main Sister 3 times, “I want her in a private room as soon as one opens up, she is American”.  Little does he know that in America not all hospital rooms are private, but I was not going to argue. 

Four person hospital room

  

      Twice a day, every day I was visited by Physiotherapist which I figured was a mixture of a Respiratory and Physical Therapist in the US.  The Physiotherapist would do some technique on my back which felt like a hard massage combined with pounding motions to loosen up the infection in my lungs.  I also received nebulizer treatments four times a day and had continual iv antibiotics going.  On the 3rd day after being admitted my labs for H1N1 (the swine flu) came back and were positive.  Then I was moved to a private room and everyone had to wear a mask when entering my room.  Adalyn was not too keen on wearing a mask so when she visited I wore one instead.  Luckily the treatment for H1N1 is just a pill.

      On my 5^th day there, the doctor said I was done with my iv antibiotics and asked if I would like to stay longer or go home.  I guess if you are paying of course they want you to stay, but I choose to go home.  He wrote out prescriptions for 3 medications and we took them down to the pharmacy within the hospital and they were filled for free!   Now there is a thought, if you want your patients to continue their course of meds, I am sure giving them out free after discharge would do it.

      Overall the care I received was very similar to US hospitals but I thought I would notate the differences and similarities.

Differences I noticed between SA and US hospitals:

In SA:

HIPPA does not exist.  There is a list at the front desk when you walk in telling you who is admitted and what room they are in.  Charts are also kept in the rooms, but not locked so if I was nosey I could have read someone else’s chart I guess.

Hopsital beds are manual

No Kleenex is kept in the rooms

No Wifi and only 8 tv channels (lucky enough there were 2 in English)

No hospital gowns, you wear your own clothes

Strict visiting hours (1/2 hour at 11, ½ hour at 3 and an hour at 7).  They ring a bell when visiting hours are over.  Thankfully in my private room we did not have to abide by these hours.

Medicine is kept in a locked cabinet in your room

No electronic charting

Similarities I noticed between SA and US hospitals:

Care was very much the same

Medicines and most equipment were the same

Routines were the same, doctors rounded in the morning, orders went out and then treatment started.

Visited by nurses all the time, even student nurses

They woke you up early for labs

The biggest difference I noticed was not in the care, I received wonderful care and would not be concerned about having to go back if something else came up in the future.  My shock was with the cost of care.  To sum it up:

$200 ER visit for 5 hours of care and 2 iv antibiotics

$60 for 5 prescriptions

$30 ER follow up visit

$54 chest x-ray

$1,500 for inpatient stay (Admitting would not let me be discharged until I settled my bill with the financial dept.  I of course thought, “okay, this is where they tell me the huge amount I owe”.  But instead he said, “we owe you a $500 credit as you overpaid and we want to make sure you get your refund before you leave”.  I was shocked and welcomed the refund.
$842 for inpatient labs

$172 for the Physiotherapist treatment (8 treatments)

$198 for the Doctor’s care (5 days of visits)

Totaling $3,056 for 5 days of good inpatient care

*for most of my bills, if I paid within 30 days, I would get a 20-40% discount. 

      I don’t know where else in the world you can get good care by even American standards for that amount.  I have submitted by receipts to Aetna so we will see how they process SA claims, or if they can understand them as some words are not in English.  I am very thankful to Wilger’s Hospital, Dr. Venter and the ER doctor for providing great care to someone who is very familiar with US hospitals and quite skeptical of care outside the US.  They have proven themselves to be a good option and my view point has changed.  I think it would be cheaper for self-pay US citizens to fly first class to SA than it is to go to a US Hospital for the same care.