Let’s talk business: a public-private partnership in soft tissue knee surgery
Keywords:public-private partnership, arthroscopic knee surgery, orthopaedic surgery, knee
Background: Public-private partnerships (PPPs) in orthopaedic surgery can help alleviate the burden on state hospitals and provide additional training capacity but need to be feasible with acceptable patient experience. The aim of this retrospective study was to analyse the costs, training capacity and hospital experience of a PPP to process knee arthroscopy of state patients in a private hospital.
Methods: This retrospective analysis was done for cases seen at a knee unit in a state hospital and operated on in a private facility between April 2019 and December 2019. The costs analysed included theatre time, bed nights, consumables, implants and salaries. The increase of theatre capacity and training exposure for registrars was evaluated. Furthermore, the hospital experience of the patients was assessed, using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score.
Results: Thirty-two participants (23 male, median age 24.5 years, interquartile range 10) were included. The average cost per patient was R44 442.71 (standard deviation [SD] R20 037.73). The average implant cost was on average R16 123.87 (SD R13 775.62), theatre time (including anaesthetists) was R20 816.22 (SD R7 865.36), consumables amounted to R5 206.68 (SD R1 855.53) and bed nights were R2 295.93 (SD R1 260.09). The surgical capacity of the unit increased by 16%. In 30%, trainees operated as primary surgeons under direct supervision and in 19%, the supervisor was unscrubbed. In 51% of surgical time the consultant was the primary surgeon, teaching trainees. The HCAHPS score was good to excellent in all categories but discharge communication.
Conclusion: The study found exposure to surgery for trainees was increased and patient satisfaction was excellent, although discharge information should be improved. This study also provides important information on a model of cost sharing in soft tissue knee surgery which can be used in future PPPs and to plan for National Health Insurance.
Level of evidence: Level 4