An analysis of healthcare and malpractice liability reform : aligning proposals to improve quality of care and patient safety

Abstract

The South African health system faces numerous challenges. A large majority of the population are dependent and have to contend with a dysfunctional public sector. The quality of care patients receive is severely compromised. Systemic factors, that are particularly prevalent in state facilities, exacerbate the problem. As a result, patient safety is endangered and many avoidable adverse events occur. These adverse events bring about grave consequences for the practitioner involved, the healthcare system with regard to the detrimental impact on resources and, most importantly, the patient. It must be acknowledged that many of the problems and institutional weaknesses that prevail in the public sector have been inherited. Recognising this, however, does not absolve the current administration, as many of the challenges are compounded by poor policy decisions and failures in crucial areas. This necessitates the need for a critical evaluation of proposed reforms. This dissertation conducts such an evaluation to investigate whether the National Health Insurance will adequately address the deficiencies of the existing system and ensure that South Africans have access to affordable, quality healthcare services. It is argued that there are many unanswered questions in the proposal as set out in the Green Paper. An insufficient case is made for the complete reform of the healthcare system. The adequacy and effectiveness of the NHI, as the preferred mechanism with which to achieve positive health outcomes, have not been established. There are also serious concerns about the affordability thereof as well as the transparency of the process. Medical malpractice is also investigated. The dissertation provides an overview of the current regulatory and civil liability framework, before evaluating the current malpractice situation. The increasing costs and frequency of claims have been identified as a threat to the existing healthcare system and the successful implementation of the NHI. The dissertation assesses the problem, by considering the extent, effects and causes of increased malpractice litigation. It is argued that the existing malpractice system may be inadequate at promoting and ensuring quality care and patient safety. Reforms that align the objectives of the health system with those of the medical malpractice system should be implemented. Conventional reforms that would merely alter the current system will be insufficient. Fundamental reforms should thus be considered. A patient-orientated approach will be crucial in this regard. Patients are the most severely affected by malpractice and will have to contend with the consequences of malpractice litigation as well. Reforms, seeking to ensure that patients receive compensation whilst making healthcare safer, should be central to any discussion. Concrete research is necessary. Information on South Africa’s health system as it relates to the burden of iatrogenic injury and the causes and avoidability thereof should be studied. The malpractice system should also be scrutinised. Reliable data is required on the number of malpractice claims filed, the causes, costs involved and the difficulties experienced in obtaining compensation. Policy decisions that would ensure that quality care is provided and that patient safety is emphasised must be informed by the necessary inquiries.