Cost of giving birth set to spiral

As the professional body for South Africa’s obstetricians warned that sky-high insurance rates were driving specialists away from the field, hospitals in Nelson Mandela Bay said this week they still had enough obstetricians, but fees for patients giving birth at private hospitals were set to skyrocket as doctors’ annual insurance payments increased to R800 000 a year.

Lourens Bekker, CEO of one of South Africa’s major hospital groups, Life Healthcare, said they would engage with the doctors to find an innovative solution to the imminent skills crises caused by high insurance rates.

Netcare Greenacres Hospital spokeswoman Adele Kennedy said they had 14 maternity beds at the hospital, which were in constant high demand.

She said there were three permanent obstetricians at the hospital.

Life Healthcare’s regional manager for the Eastern Cape, Bruce Janssens, said there were still five obstetricians at both Life St George’s and Life Mercantile hospitals.

He said they tried to promote natural birth where possible.

“The high cost of maternity insurance for obstetricians is a common challenge that we share with all other maternity hospitals in the country,” Bekker said.

Dr Johannes van Waart of the South African Society of Obstetricians and Gynaecologists, said the cost of litigation insurance was a major factor in the increase of medical fees charged by obstetricians.

“Obstetricians have no alternative but to pass this on to patients – or stop obstetrics, as has widely been reported.”

Insurance this year was R650 000 a year and next year it would be close to R800 000, Van Waart said.

“Many doctors have responded by either raising fees to reduce delivery numbers, or alternatively by doing more caesarean deliveries to avoid the unpredictable pitfalls of natural deliveries.”

“Clearly malpractice insurance is no longer affordable to many obstetricians and gynaecologists, and the collapse of private obstetric (midwifery) care is now a real possibility, and has begun in several smaller centres.”

Van Waart said the cost price of a delivery was in the region of R13 000 and medical aid reimbursement was typically about R4 600.

“This shows that obstetrical care for private obstetricians is not worth it, thus many have already stopped practising obstetrics.”

“There is nothing inherently wrong with delivery in the public sector – but a flood of previously private patients to public facilities will result in chaos,” he said.

The maternity ward at Dora Nginza Hospital in Nelson Mandela Bay performs 800 deliveries a month at the moment.

Van Waart called for urgent attention to this issue by the National Department of Health. He said medical aids had called on obstetricians to do fewer deliveries by C-section.

According to the District Health Barometer published for 2015, the C-section rate for Nelson Mandela Bay – 41% of all births – is double the provincial average of 20%.

VanWaart said older and experienced obstetricians had stopped midwifery and this was putting further stress on younger and less-experienced doctors.

“Legislation may go a long way in curbing legal fees and the huge amount of settlements. Capping payouts is an obvious way to prevent the escalation of costs.”

He said a programme of guidelines had been drawn up and a review panel established at private hospitals to address the looming crisis.

A report compiled by the Medical Protection Society, which provides South African private practitioners with malpractice insurance, said the value of legal claims against doctors had increased by an average of 14% each year between 2009 and 2015.

An attorney specialising in medical malpractice in Nelson Mandela Bay, Francois Swanepoel, said a claim for medical negligence during birth could vary from between R80 000 to R100 000 to several millions, depending on the situation.

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