DEFINING THE VALUE OF REHABILITATION FOR DISABILITY AT PHC LEVEL IN THE PUBLIC HEALTHCARE SECTOR IN THE SOUTH AFRICAN CONTEXT

R. Maart¹, L. Morris², D. Ernstzen¹, G. Mji³

¹Stellenbosch University, Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Tygerberg, South Africa, ²Qatar University, Department of Physical Therapy & Rehabilitation Science, Doha, Qatar, ³Stellenbosch University, Centre for Rehabilitation Studies, Tygerberg, South Africa

Background: Value-based healthcare (VBHC) entails providing efficient, quality healthcare based on the desired outcomes of the patient. It is central to achieving Universal Health Coverage (UHC). With the global increase in healthcare expenditure, governments are obliged to re-prioritise budgets and healthcare services to ensure efficient and effective healthcare spending without compromising service coverage. South Africa has ratified the United Nations Convention on of the Rights of People with Disabilities and has to stay true to this commitment. People with disabilities (PWD) are faced with various barriers and often have worse health outcomes compared to their non-disabled peers. Rehabilitation is integral to overcoming these barriers and facilitating social participation and functional reintegration of PWD. Internationally, the benefits of rehabilitation have been illustrated through cost-effectiveness studies in relation to health outcomes. However, the value of rehabilitation for disability has not been defined in the South African context.

Purpose: To determine how the value of rehabilitation can be defined in the South African context in a PHC setting.

Methods: The value of rehabilitation was explored through three phases namely: phase 1) a qualitative study exploring rehabilitation experts’ perspectives on the status quo of rehabilitation in South Africa and their perceptions of value; phase 2) a healthcare policy review to investigate value determinants within South African policy and to track the progress of rehabilitation against the National Health Plan’s mechanism for rehabilitation and 3) a retrospective record review to identify value determinants in patient records in order to calculate the value of rehabilitation.

Results: This study illustrated that various variables and factors need to be considered when defining and determining the value of rehabilitation. Barriers and facilitators that could influence value-based rehabilitation services were highlighted. Twelve rehabilitation stakeholders considered different patient and service delivery factors, health outcomes and costing factors as important in determining value. Fifteen South African healthcare policies included various aspects pertaining to value and adequately addressed the rehabilitation needs of PWD as a collective. Forty patient records were used to identify value determinants that could inform the calculation of value. The estimated rehabilitation costs compared to potential consequences and costs incurred in lieu of receiving rehabilitation illustrated that more could be gained than "lost".

Conclusions: The value of rehabilitation in the South African context can be partially determined through considering health outcomes and costing analyses. In addition, the patient-perspective, quality, evidence-based practice, safety and efficiency need to be considered. This research is important to ensure the needs of PWD are addressed through implementing and practicing value-based services and can inform policy and clinical practice. The study results and important considerations for future research were combined to create a framework to define and determine the value of rehabilitation.

Implications: Demonstrating the value of rehabilitation could influence policy and practice in South Africa. This is necessary as South Africa's health system reforms are underway and the need to prioritize rehabilitation is essential to address the needs of people with disabilities.

Funding acknowledgements: The contribution of the following funders is acknowledged: National Research Foundation of South Africa; Physiotherapy department at Stellenbosch University, Ninety-One.

Keywords:
Value
Rehabilitation
Disability

Topics:
Disability & rehabilitation
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: Stellenbosch University

Committee: HREC 1

Ethics number: S19/07/123 (PhD)