AG warns against ballooning medical claims

The Auditor-General warns against increase in medical claims. File picture: Henk Kruger/Independent Newspapers

The Auditor-General warns against increase in medical claims. File picture: Henk Kruger/Independent Newspapers

Published Nov 11, 2023


The Auditor-General has explained how government has missed its target it set five years ago to reduce medical claims by 80% from R70 billion.

Mmule Thipe, the engagement manager in the office of the auditor-general, said the target was set in 2018 that by 2024 medical claims should be sitting at R18bn.

But this has not happened instead the current claims were R68bn, and it was far from the target.

Thipe and other senior officials from the office of the auditor-general were briefing the Standing Committee on Public Accounts on medical claims this week.

She said there were many reasons why the State has not been able to reduce medical claims as planned.

Thipe said the claims were putting pressure on the health system and this affects service delivery.

“The target that was set was that the government wants to see contingent liability of medical legal claims reduced by 80% (under R18bn) in 2024 from the baseline of R70bn in 2018.

“Currently, we are sitting at R68bn of these cases and R68bn is exclusive of the Limpopo provincial department and this is because they had not signed the report when we are reporting this now. The chances are that it is more than R68bn,” said Thipe.

She said the claims have an impact on the delivery of services in the healthcare sector.

Another senior official from the office of the auditor-general Maryke Schneigans told members of Scopa they visited some of the healthcare facilities across the country and they discovered poor record keeping, lack of administrative staff to manage medical records, delays in getting medical records and missing records.

These problems make it difficult to defend some of the cases in court.

The State is facing lawsuits across the country over negligence by provincial departments.

“In some of the instances (provincial health departments) were unable to provide required medical records. This may lead to an increase in medical legal claims as cases may not be defendable in a court of law.

“It’s also important that medical records be there to enable these legal services directorate to go and defend cases in a court of law. At 15 out of 27 healthcare facilities that we visited across the nine provinces shortages were reported among administrative staff members responsible for the management of medical records.This had a negative effect on the management of medical records,” said Schneigans.

“At 15 of the 27 healthcare facilities were either misfiled or were not always filed in a systematic or orderly manner as a result of limited infrastructure or shortages in the responsible administrative staff. In some cases medical records get lost in these medical facilities. If these records were needed for medical clams they will not be available,” she said.

Head of portfolio in the office of the AG, Andries Sekgetho said medical claims were now becoming a risk to the department of health.

If the claims continue to increase they will affect a number of areas in the department.

He said funds that could have been used elsewhere were now diverted and spent on the claims.

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