In the next three years, South Africa can expect to see private obstetrics practices collapse as indemnity insurance costs continue to climb and they are litigated out of practice.
Health experts have raised awareness around an escalating crisis in obstetrics during Pregnancy Awareness Week, marked from February 8 to 14. They say numerous practitioners are leaving active practice due to extremely high indemnity insurance costs, which are expected to reach up to R850 000 this year.
Health Department spokesperson Joe Maila said the department had met the South African Society of Obstetricians and Gynaecologists to work together to find sustainable solutions. Maila has warned that if they leave active practice, the health sector would not cope.
“We are aware that they are being litigated out of practice and that the indemnity cover is expensive,” he said.
The organisation's president, Johannes van Waart, said: “This is a real, real crisis. Our indemnity insurance in the last four years has gone from R250 000, to R330 000, to R650 000 last year, to R850 000 this year.”
He said obstetricians would need to do 17 deliveries per specialist monthly just to cover insurance. Last year, obstetricians would need to do 13 deliveries per specialist monthly.
There are no private obstetricians practising in Worcester, and only two in practice in Paarl, Van Waart said.
“At this point, one-third of the national health budget is taken up by legal claims.”
Van Waart said obstetricians were constantly trying to improve their service through the BetterObs Programme, devised with the intention of promoting safer deliveries, healthier babies, better outcomes all-round and, consequently, decreased opportunities for litigation.
Without private obstetricians, the state health system would not be able to manage the 140 000 deliveries in the country yearly, he added. “It is not sustainable.
"If it continues like this, private obstetricians will collapse in the next three years. There will likely not be private obstetrics practice, or it will cost a fortune.”
Health-care management company PPO Serve says insurance providers attribute high fees to the inconsistent way maternity care is practised in South Africa.
“There is a lot of deviation from standard-care protocols, and treatment decisions aren’t well documented. Insurers won’t risk court when doctors are sued, they choose rather to settle in the face of too little evidence over how treatment decisions were made,” said PPO Serve chief executive Brian Ruff.
According to Ruff, structural change requires the reorganisation of maternity care to a team aproach. “Obstetricians should head up multidisciplinary teams of health-care professionals who share patient information, treatment plans and the fee for their collective services.
"Indemnity insurers offer lower rates to teams because they have the capacity for holistic and proactive care, better record-keeping and better communication with patients and their families.”