What if South Africa woke up one day and there is not a single obstetrician in private practice in the country? What will happen if every child born is born in the public hospital because all the maternity wards have shut down in private practice? This is the reality that is facing the SA Society of Obstetricians and Gynaecologists in the next four years.
In an interview with TMG Digital‚ society president Johannes van Waart explained how hundreds of obstetricians are leaving their practice due to the amount of insurance they have to pay just to do their jobs.
“There are insurance companies that offer cover to obstetricians. In order to be able to practice‚ each medical practitioner has to have some kind of insurance covering them should and adverse event occur and there needs to be compensation to the patient. These insurance companies determine the risks and can determine what they expect in the next couple of years.”
There are currently 140‚000 babies delivered in private hospitals a year. When the figure is divided by the number of obstetricians‚ it comes to 13 deliveries per month. Obstetricians should be paying about R5‚000 per delivery to insure themselves.
“But this does not take into account all the overheads‚ the machine and the staff. The medical aid only pays what it calls a 100% fee of R4‚200 a month.”
According to Sasog calculations‚ obstetricians need to charge about R13‚000 per delivery to cover for all expense incurred in the delivery of just one baby.
But things are getting worse for them.
“Last year‚ our insurance cost rose by 45%. What happens if people cannot afford it? They then stop doing obstetrics and just do gynaecology… This means there are no obstetrics and the labour wards do not have any clients coming in for deliveries and eventually people go to the state [hospitals].”
This‚ van Waart said‚ would take the 140‚000 babies from private to public hospitals which are already struggling with the high number of babies being born at their institutions.
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Rapport reported in September that Life Midmed Hospital in Middelburg‚ Mpumalanga would shut down its neonatal ICI and obstetrics ward‚ which handles 100 deliveries a month. There will be no obstetrician in private practice in Worcester by April next year.
This year‚ about 50 of obstetricians stopped doing obstetrics and Sasog is expecting 50 to 100 more obstetricians to stop doing private practice from a pool of 500 that were in practice at the beginning of the year.
“There is going to be probably about 200 to 350 obstetricians left next year. If things continue as they are‚ by 2020‚ we will not have a private practice obstetrician in this country‚” Van Waart warned.
To retain obstetricians‚ Sasog has been embarking on an intense programme of training the practitioners on standardizing the practice‚ “ensuring that every person does the same thing”.
Midwives are also being trained to further improve the quality of control systems in the maternity ward.
Lawyers are the ones cashing in on the whole situation. Because of the depleting funds paid out by the Road Accident Fund‚ lawyers have moved to dealing with obstetrics because it gives a better “return“.
These lawyers go to the wards and find out which are the babies in the neonatal unit and propose that mothers claim from the obstetricians‚ he explained.
On November 11‚ Sasog met with Health Minister Aaron Motsoaledi to ask for intervention in the crisis.
Sasog put four requests to the minister which it believes will save the profession:
-capping of the claims;
-structuring of the payout – monthly or annually;
-certificate of merit‚ if doctors are found to have not been negligent‚ the lawyers who must pay for the cost;
-mediation process must take place before the claim goes to court.
Van Waart said some of the reasons claims are lodged against obstetricians were due to patients who do not follow doctor’s advice. One is stop smoking‚ as well as adhering to medical check ups and testing of blood pressure regularly.
“If private patients have to go to the state‚ their fees on claims will go up. At the moment there are claims to the total of R49-billion against the state‚ about 80% of that is on obstetrics. This means only two-thirds of the health budget will be mobilized for healthcare.”
Another follow-up meeting is planned with Motsoaledi to further engage him on this crisis.
