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A key driver of these high malpractice premiums is scant documentation of treatment decisions and poor compliance with standard care protocols.
Insurance providers will not risk court when doctors are sued, choosing rather to settle in the face of inadequate documentation of the care provided.
This is a consequence of doctors working in isolation at what should be a team sport. An individual practitioner cannot follow protocol designed for medical teams, nor can they manage the detailed records of the high number of patients required to make their practice profitable.
At the start of 2017, the future looked bleak – but, integrated team models are making the retention of obstetricians possible. When maternity care is delivered by teams, the risk of poor outcomes is reduced, full documentation is routine, and because of that, insurers are willing to discount indemnity premiums for the healthcare professionals in the team. In light of this, I predict that in 2018 we will see the following trends in maternity care:
Healthcare is best delivered by teams with various skill sets and expertise. Maternity care is no different. Currently, specialists and independent midwives are paid separately and must compete over patient care, rather than collaborate. This can result in delays in the transfer of patients who develop complications, creating risk for both the midwife and the accepting obstetrician, as well as a higher chance of poor outcomes for the patient. A set-up in which obstetricians and midwives work together for a team fee prevents this, delivers more holistic care and promotes record-keeping. Such teams, of 12 midwives and three or four obstetricians, can together deliver 300 babies per month – a huge untapped capacity. To date, two clinician owned teams are actively practising this way in South Africa – one in Berea, Johannesburg and another in Central Durban – both under the brand name The Birthing Team.
Crises often drive innovation, and the private maternity care sector in South Africa is a dire need of it. I strongly believe that teamwork is the solution, capable of delivering the high value of care that allows for lower malpractice insurance costs and better health outcomes for patients.