Public hospital bosses countrywide are allegedly tipping off lawyers to possible malpractice cases in their own hospitals in exchange for kickbacks. Health Minister Dr Aaron Motsoaledi is quoted in City Press as saying that he had ordered an investigation into the CEOs – who he refused to identify.
CEOs are allegedly working in cahoots with not only private lawyers, but attorneys employed by the state. The latter, Motsoaledi claimed, were deliberately "mismanaging" cases or under-preparing their defence "so that we lose the case". According to the report, Motsoaledi claimed some CEOs "deliberately fail to apply norms and standards", hoping something would go wrong during patient care or treatment. When it does, he said: "They inform lawyers to start litigation and give them all the relevant information and documents that may help them win the case."
Motsoaledi said this was not just unethical but a crime that should be punished. "They are defrauding the state and lining their pockets, all in the name of patients who might have been victims of negligence or malpractice. If the lawyers cared about patients, as they claim, they would not be taking huge chunks of money from the civil claims payout." Motsoaledi said investigators from the department were working around the clock to bring the implicated CEOs to book.
The report quotes Dr Poppy Ramathuba, chair of the public sector doctors’ division of the SA Medical Association, as saying she was not aware of CEOs' involvement in these medical-malpractice syndicates. But she said "there are several cases where nurses and admin clerks are being investigated for selling patient files to lawyers specialising in malpractice". "Some of these healthcare workers are alleged to be on the payroll of lawyers. They receive R500 for each file they hand over to lawyers and get a lot more when the case has been successfully litigated," Ramathuba said. "Some of the medical errors that end up in court are man-made – just so people can enrich themselves. To those who do it, it’s all about the money. But to us, as doctors, it’s about innocent lives that are lost – all because of greed," she said.
Motsoaledi says he has appointed a six-member team of experts in medicine, law, IT and administration to investigate allegations lodged against the Health Professions Council of South Africa (HPCSA). This after the Minister received complaints about governance, efficiency, effectiveness and sometimes even the competency of the management of the HPCSA, reports Polity.
Motsoaledi said the HPCSA initially attempted to set up a committee to resolve matters internally but after his meeting with the council’s president, Professor Sam Mokgokong, they reached an agreement of establishing an independent team outside the council. "The team will investigate and make findings with regard to whether or not a forensic audit needs to be conducted,2 said Motsoaledi.
The minister said issues under investigate include the governance responsibilities of the HPCSA, procurement procedures followed with the acquisition of the ORACLE information system, allegations of maladministration made by the staff who have resigned, and the fitness of the CEO and the COO to run the organisation.
He said the team will also look into whether the state of affairs has affected the effectiveness and efficiency of the HPCSA, and if there has been any impact on the training of health professionals. The minister is expecting to receive findings and recommendations from the investigation process in about two months so he can take further action.
"The team has been given 60 days to complete their work, but may ask for extension if they deem necessary. The team will provide more information on how they will conduct their work in due course,2 said Motsoaledi. HPCSA president Professor Sam Mokgokong said the day-to-day running of the HPCSA would continue.
The DA says it welcomes Motsoaledi's announcement. Dr Wilmot James, DA shadow minister of health notes in a Politicsweb statement that ‘the DA will be making submissions of our own on numerous complaints by the public and health professionals to the task team in order to assist its investigation.
"The DA will continue to monitor and report maladministration and inefficiencies at the HPCSA to the task team and will follow up to ensure that remedial action is implemented.
"We further call on the Health Minister to table the task team's findings and recommendations before Parliament for consideration as soon as the task team's report is completed."
Medical specialists, charging high fees and guiding patients into the wide open gates of expensive private hospital groups, are, meanwhile, of particular interest to Motsoaledi, reports Moneyweb. "Profit-maximising specialists and hospitals are able to exert their dominance through price increases and price discrimination with relative impunity, and currently have no need to compete on either price or quality in order to attract patients," he states in the Department of Health's (DoH) submission to the Health Market Inquiry.
Together with private hospitals, they are viewed as the drivers of price changes as well as the utilisation of services, as their diagnosis and treatment recommendations direct patients to hospitals where treatment is provided. "Specialists are, therefore, the main drivers of demand for all expensive services, including hospital, medicine, devices and diagnostic services," says Professor Alex van den Heever, chair of social security at the University of the Witwatersrand, in his Review of Competition in the South African Health System.
The report says medical schemes expenses on specialists and hospitals have indeed increased significantly over the past decade. Total healthcare benefits paid per beneficiary per month increased by 42% from R623 in 2000 to R882 in 2011 in real terms. It appears to be largely driven by the increase in benefits paid for private hospitals (an increase of around 82% since 2000) and medical specialists (an increase of around 74% since 2000).
Submissions from the role-players however differ markedly on the underlying reasons for the high expenditure, the report says. The South African Medical Association (Sama) says it is not doctors who are driving up healthcare costs. A closer look at the expenditure of medical schemes shows that hospitals, allied health professionals and non-healthcare costs consume together 54% of medical scheme risk pool funds.
"Specialists have been maligned in the medical and lay press for being the major cause of healthcare inflation, but have only gained 10% market share from 18.3% to 20.3% from 1997 to 2013 (including radiology and pathology costs) thereby disproving these allegations," Sama argues.
The Board of Healthcare Funders says specialists are charging up to 300% more than the amounts medical aid schemes allow, but according to the South African Private Practitioners Forum (SPPF) over 80% of practices in the specialist disciplines of physical medicine, psychiatry, radiotherapy, cardiology and oncology, charge no more than 120% of scheme rates.
The report says while many people can't afford specialists, South Africa also cannot afford to lose their skills. The country suffers from a chronic shortage of specialists across all categories in both the public and private sectors. It has around 20 specialists for every 100 000 people. This is one of the lowest ratios of doctors (GPs and specialists) to population of the BRICS countries (Brazil, Russia, India, China and South Africa), research shows. Reasons include emigration and medical school constraints, but their scarcity also gives the specialists market power, says the DoH.
[link url="http://www.citypress.co.za/news/cash-scandal-hits-healthcare/"]Full City Press report[/link]
[link url="http://www.polity.org.za/article/probe-set-up-for-medical-litigations-2015-03-11"]Full Polity report[/link]
[link url="http://www.hpcsa-blogs.co.za/healthcare-inquiry/"]HPCSA enquiry terms of reference[/link]
[link url="http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page72308?oid=1010854&sn=Marketingweb+detail&pid=90389&utm_source=Politicsweb+Daily+Headlines&utm_campaign=9a39cffee5-DHN_March_12_2015&utm_medium=email&utm_term=0_a86f25db99-9a39cffee5-130040921"]Full Politicsweb statement[/link]
[link url="http://www.moneyweb.co.za/news/economy/medical-specialists-cost-cowboys-or-just-given-a-bad-rap/"]Full Moneyweb report[/link]
[link url="http://www.healthinquiry.net/Public%20Submissions/Department%20of%20Health_Submission.pdf"]DOH's full submission to inquiry[/link]