With insurance liability costs for private obstetricians pushing close to R1m annually, innovative programmes are being created to retain the specialists in the sector.
Last year the SA Society of Obstetricians and Gynaecologists warned of an impending collapse of the profession in the private sector as indemnity costs resulted in a continual climb, forcing between 50 and 100 professionals to leave annually.
“The costs of medical insurance cover have increased a thousand fold, I think, in the past five years. When I started I was paying about R700 a month. Now we’re paying close to R100 000 a month so we can be covered to practise,” Ayanda Mbele told City Press this week.
Mbele, who has been an obstetrician for 12 years, was speaking at the launch of a relatively new maternity care programme, named The Birthing Team, at Netcare Femina Hospital – the third hospital to roll it out.
The programme delivers end-to-end maternity care in a private hospital. This is for a fixed all-inclusive capped fee of R21 000 for women without medical aid who can save money towards private care. It is also targeting those who are already members of a scheme.
As a result of rising indemnity fees, obstetricians have had their workload increased. They now have to take down patients’ medical histories and check blood pressure and weight measurements, which could be done at primary level or by a midwife.
They have been forced to raise their service costs, making private maternity care unaffordable for many women.
“Because you’re alone [in your own practice], you must see a lot of patients to be able to cover your insurance. Then what happens to the quality of care you offer because you have to do non-obstetric [including administrative record-keeping] things?
“This programme uses obstetricians effectively in a team so that obstetricians do what they are supposed to do, and midwives do what they’re supposed to do,” Mbele said.
Brian Ruff, co-founder of Professional Provider Organisation Services, which is providing support to the programme, said one of the major issues in the private sector was the “fee for a service” system. It does reinforce professionals working in silos, but it will slightly add to the patient’s medical bill.
“Healthcare is not an individual but rather a team sport. The fee for a service system currently in place has created a misplaced sort of competition among professionals.
“Through this programme, we’re trying to make teamwork work in the private sector. The multidisciplinary team (MDT) of midwives and obstetricians are structured to deliver a specific product that is safe and affordable healthcare for women,” Ruff said.
Through this teamwork, Ruff said, liability risks would be reduced and the rate of Caesarean sections would also be reduced.
Mbele said: “Decisions will be made as a team. Remember, if you work alone, you don’t have anyone to consult with to exchange views on a case. We hold MDT meetings where we discuss cases, and everyone’s views matter. No unilateral decisions will be made.
“Based on that, you’re able to practise evidence-based medicine. If there is no reason for a C-section, we’re not going to do it. The key thing is proper assessment and a team approach to making decisions,” Mbele said.
Mothers-to-be will book an initial comprehensive screening, priced at R1 999, before signing on to the full programme, which costs an additional all-inclusive R19 000.
A personalised care plan is developed for the expectant mother based on her individual clinical need. The fee will include blood tests, at least three ultrasound scans and a minimum of eight antenatal visits – six with a midwife and two with an obstetrician, more if needed.
The birth itself, the team says, will mostly be normal vaginal delivery, but emergency Caesarean sections will also be covered in the fee. After the birth, there will be follow-up visits at three days, 10 days and six weeks.
Mothers who are 28 weeks or more pregnant will not be eligible for the programme. Women are encouraged to begin their journey at 12 weeks.
“At this appointment, we assess the development of the foetus and we can pick up if the baby has any problems. We can also refer or include specialist care for complex or high-risk pregnancies early on. In cases where women have pre-existing conditions, such as chronic hypertension or HIV, the cost will be slightly higher because they will be using more services,” said Howard Manyonga, head of the birthing team.
Mbele said he was already referring his cash patients to the programme, which officially starts on May 2.
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