Soaring medical malpractice litigation in South Africa and its implications for the implementation of the proposed national health insurance scheme.

Abstract

South Africa (SA) is a new democracy since 1994 with a new constitution that outlaws all forms of discrimination and affords equality to all men and women who live in it. The previous regime had entrenched discrimination based on race where the majority non-white population was denied privileges afforded their white counterparts. This arrangement ran for a period longer than 300 years and has resulted in abject poverty and lack of education for the majority black population. Poverty and lack of education are significant hindrances to development and when compounded by a burden of disease will further stymie development. Provision of free healthcare and education would assist the previously disadvantaged communities as it will ensure that the little resources they may have, can better be utilised on other needs such as food and clothing. This study will focus on the provision of free healthcare and not free education. South Africa has inherited two systems of healthcare, one public and the other private, which are seemingly in competition with each other. The public healthcare looks after most of the poor population whereas the private services few individuals with affluence as it is fee-based. Perhaps it would be ideal to have the two systems of healthcare functioning synergistically rather than antagonistically. The proposed National Health Insurance scheme (NHI) for South Africa, with pilot sites already running is an attempt by the government to achieve the goal of universal healthcare which is in line with the United Nation’s Millennium Development Goals (MDG) targeted at poverty reduction, but is perceived as a threat to private healthcare because of the position adopted by government in the NHI white paper, which states that the role of private healthcare will be only complimentary to the NHI and provide those services which the NHI will not be providing. This is a clear threat to the existence of private healthcare. Implementation of the NHI scheme is not without challenges such as infrastructure, personnel and financial resources like the soaring medical malpractice litigation. There are numerous factors which are contributing to the soaring medical malpractice claims worldwide and South Africa is not exempted, as recorded that in the past four years the Department of Health (DOH) had incurred R1.2 billion in legal costs related to medical malpractice claims. Therefore, soaring medical malpractice claims threaten the survival of the present healthcare systems and will further hinder the implementation of the NHI scheme as it ravages the financial resources allocated for healthcare provision and threatens the existence of the high-risk medical specialities (like obstetrics and gynaecology, neuro-surgeons and orthopaedic surgeons). This trend is likely to worsen in South Africa as medical malpractice claims continue to devour financial resources intended for the provision and improvement of healthcare services. The National Health Service (NHS) in the United Kingdom (UK) celebrated its 70th birthday recently, was a response by the government to provide universal access to quality healthcare for all the citizens as a response to the devastation of World War II. The experience of the NHS provides insights into the challenges of implementing a universal healthcare service in an inequitable society.