• 28 Nov 2016

    SpesNews Volume 136

    The volcano has blown its top!

    2016 will be remembered as the year when medical malpractice insurance (MedMal), also known as professional indemnity, reached such epic proportions that many specialists, especially obstetricians, have finally opted out of certain procedures or services. This was brought to a boiling point by a culmination of factors, including:

    • The Medical Protection Society (MPS) has left a sour taste in the mouths of many South African doctors as the UK based MPS service desk, following their disinvestment in South Africa, simply didn’t provide the efficiencies, appropriate support nor comfort required to their members (especially in times when you need your safety net the most).

       

    • Premium increases have soared over the medium term, and the change in RAF legislation has moved traditional RAF legal firms to focus more on Medical Malpractice claims. This has led to a slew of new cases of litigation against private and state healthcare providers. These cases are also being reported on more frequently in the press.

       

    • An increase in legal cases was not just seen in the traditional “clinical malpractice” environment but also in the huge increase in HPCSA cases and Medical Scheme industry forensics. The MPS and other insurer’s structures do not cover nor provide expert support for most of these type of cases.

       

    • All of the existing MedMal products in SA are merely insurance products, with none of them

      • providing the full spectrum of benefits required in the complex SA healthcare market in which a healthcare professional must also comply with business, consumer protection and cyber risks.

      • really addressing the root of the problem or providing a risk mitigation programme which can realistically minimize future risk and thereby calm down the medico-legal frenzy in the market.

    Over the years SpesNet has been advocating that doctors must align with well-established insurance firms and should not join the fly-by-night options who have lured doctors with new premium structures. We have facilitated many of the MPS Mastering your Risk workshops but have become increasingly frustrated with the lack of proper practice tools, self-assessment guides, as well as a lack of training for practice staff and those impacting on the doctor’s work environment.

    We were concerned when new legal opinions surfaced and stated that MPS is claiming to be a mutual and therefor does not have to be registered with the Financial Services Board (FSB). Should this be the case, it puts all its members (including the author) at risk because we are now at the mercy of a company who is not an SA registered entity and who do not comply with local FSB requirements.

    Should an MPS member for any reason feel disgruntled with the service or decisions made by MPS, he or she

    • does not have a formal contract to which they can revert, and

    • in the event of a dispute, must in fact take legal action against MPS in London

    Emergency services required

    To bring sanity back into our market, it is imperative that all stakeholders work together and that there are real changes in the way healthcare services are delivered - with patients truly experiencing better quality of care and improved doctor-patient communication.

    On the other hand, patients must also realize that they should not entertain the first legal firm wanting to initiate an expensive, time consuming and emotionally draining law suit. As with any area in our human existence, we need to communicate earlier and better - and support the drive for mediation, to the benefit of all parties concerned.

    “At the end of the day, no matter where each one of us fit into the healthcare ecosystem, we have one thing in common – somewhere, sometime we are all PATIENTS!”

    On Wednesday 16 November, the Constantia Insurance Group launched EthiQal medical risk protection solutionin Sandton. From our engagement with them, we are excited about their collaborative approach and their focus in getting as many healthcare role players as possible involved in addressing roots of the disease and not just the symptom of MedMal in South Africa.

    We trust that this is the start of a synchronised effort by all healthcare professionals, associations & societies, professional bodies and value-adding partners, as well as hospitals, funders and government to put their own agendas aside and work together to take South Africa into a new era of healthcare service delivery.

     

    Looking at the ever so important tick boxes, SpesNet’s evaluation so far confirms:

     

    Constantia is:

    • a solid sustainable business entity (owned by JSE listed company Conduit)
    • well established in the insurance market
    • a SA registered FSB company
    • amicable to new ideas and benefit designs

     

    Constantia has: 

    •  Strong and innovative leadership
    •  Skilled operational teams
    •  Ample allocation of funds for claims and reinsurance
    •  Reputable legal support and firms
    •  24/7 support by a local, experienced and credible team of experts
      •  Dr Liz Meyer
      •  Dr Tony Behrman

     

    Constantia will: 

    •  Challenge the status quo of current legal processes
    •  Follow a collaborative approach, rather than further segmenting the market
    •  A transparent partnership model with healthcare professionals
    • Value the role of the clinical societies as custodians of care

     

    The EthiQal solution will:  

    • Be backed by an International Top 3 Re-insurer
    • Have reduce premiums
    • Reflect premiums as VAT inclusive prices
    • Follow a Mediation rather than litigation approach
    • Have a Pro-active risk mitigation program, with
    • Perform individual risk assessments
    • Offer choice between Occurrence & Claims-Made cover
    • Offer options for retro-active cover and extended run offs

    As part of our commitment to ensuring that this is a true market changing and sustainable solution, we will continue to engage with Constantia / EthiQal and evaluate their processes, contracts, risk assessment and risk mitigation program.

    The cover by EthiQal is to commence on 1 January 2017. Should you have any queries or matters you want SpesNet to address, or want the EthiQal team to meet with you, your society or local group of doctors, please do not hesitate to contact SpesNet. For more information you can visit the following websites:

    SpesNet Subscription Increase 2017

    It is hard to believe that it is that time of year again. SpesNet would like to thank all of our loyal subscribers for being part of our journey in 2016 and wish each one well throughout the up and coming Festive Season.

    2016 was an exciting year and saw SpesNet launch a number of additional products and services, to further enhance the service offering to our subscriber. In line with our service promise to provide support, knowledge and technology to ensure a thriving healthcare practice, in 2016 we brought you:

    • Medical Scheme Payment Arrangement database

    • ICD-10, RPL and CPT4 coding and tariff with Health Code Index.

    • Patient Informed Clinical Consent tool.

    • Website Builder.

    • Human Resources Management and Legal assistant tools.

    We look forward to 2017 and would like to use this opportunity to provide you with our 2017 monthly fees:

    • Plan 2 subscribers – R590 (incl VAT)

    • Plan 3 subscribers – R770 (incl VAT)

Our partners

EthiQal is a comprehensive Medical Indemnity solution developed for South African Medical Practitioners by Constantia Insurance Company Limited. Local risk assessment based on South African private sector settlements only. Specialty focused support and inputs to practice management. Provision of Occurrence and Claims Made insurance cover. Insurance contracts which are enforceable in terms of South African law and Regulations.

DUXAH, The DUX Academy of Healthcare, evolved from within SpesNet, a company established by medical specialists to assist medical specialists and recently qualified registrars to negotiate the fraught business of private practice.

Optimising practice income! Get all the power, functionality, and flexibility your Specialist practice needs, plus the convenience of the Web.

ProfNet provides business management tools and practice support to maximise the income and efficiencies of private practice in the South African Allied Healthcare environment.

Evolve Medical is a leading provider of customised integrated software solutions.

When Discovery was established as a small specialist health insurer two decades ago, we made a clear and profound promise: to make people healthier. Making people healthier and enhancing and protecting their lives has evolved into our core purpose.