Malpractice costs put SA’s doctors on the defensive

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The increase in malpractice claims has increased the practise of defensive medicine by South African doctors, as well as fuelling a rise in premiums, reports Sunday Times.

Annual premiums for malpractice indemnity insurance have risen, in some cases, to almost R1m a year. It reports that doctors, particularly obstetricians, who were paying up to R250,000 a year four years ago in malpractice premiums, are now paying about R900,000 as a result of the escalation in malpractice claims.

“So, what we are saying is that before you have earned a cent in your pocket to pay for your staff or your surgery or your water and lights or your children’s school fees, you’ve got to earn R1m to cover your insurance,” said Justin Malherbe, a health-care and insurance lawyer at Norton Rose Fulbright. “What makes that so significant is it jumping up in the last four years from R250,000 to R330,000 to R650,000 to R850,000 and now just approaching R1m. That is scary.”

The report says another result of the increase in litigation is that doctors have been practising defensive medicine – they prescribe medication, tests and treatment that a patient may not need in order to protect themselves against the risk of litigation. This puts an additional burden on patients, medical aid schemes and health-care facilities.

“There’s a general feeling that doctors get sued for acts of omission rather than commission,” said Dr Chris Archer, CEO of the South African Private Practitioners Forum. This means doctors would rather do more than what is required so that they can prove that they took care in their procedures, should any litigation arise. For obstetricians who specialise in childbirth, defensive medicine means sometimes performing caesarean sections, even when not necessary. Archer placed SA’s caesarean-section rate at about 80% in private health facilities.

The Medical Protection Society (MPS) said that its data showed that in the nine years between 2008 and 2017 the number of medical claims against its members had increased 57%, and the average cost of medical claims had shot up 42%. Dr Graham Howarth, MPS’s head of medical services, Africa, would not divulge how much the association charges its members, citing commercial confidentiality.

He said the MPS had found that between 2011 and 2016, claims against health-care professionals in South Africa had increased 35%, and medical and dental claims of more than R1m had risen 121%. Research by the society found that 47% of doctors practised more defensively than they did five years ago.

Dr Bettina Taylor, clinical risk specialist at EthiQal, a division of Constantia Insurance Company, said in the report that indemnifiers provide two types of cover for health-care providers, occurrence-based and claims-made. She said with occurrence-based cover a doctor is indemnified for life for incidents that occur during the year premiums are paid. This means that even if a claim arises a few years after the patient saw the doctor, or if the doctor has retired, the indemnifier will pay as long as the doctor paid their premium in the same year of the procedure or treatment.

Taylor confirmed the historic escalation in doctors’ premiums, saying it was not clear why the MPS charged obstetricians about R900,000 for occurrence-based cover, adding that an occurrence-based policy for obstetricians in 2018, issued by Constantia, cost R595,000 with a commitment to individual policy holders that the rate would remain constant for three years where the doctor’s risk profile remained unchanged.

 

Sunday Times report

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