By Dr Graham Howarth, Medical South Africa Lead, Medical Protection

The National Health Insurance (NHI) Bill continues to generate extensive debate from across medical, political, academic and financial arenas for a range of reasons. As the legislation progresses, much of the focus has been on which areas need more detail and clarity given the significant implications the changes will have on the health system.

One of the areas where we think there needs to be more clarity is the subject of indemnity for clinical negligence claims, which has so far hardly featured in the public discourse to date.

As the largest medical defence organisation serving South Africa, Medical Protection is naturally interested in what the proposed indemnity and insurance arrangements will be for NHI-funded patients treated in the private sector, and NHI-funded patients treated by private practitioners in the state sector.

With that in mind, we recently provided a parliamentary submission to the National Council of Provinces, which has been conducting a public consultation on the NHI Bill.

In this submission, we sought to confirm our understanding that under the NHI Bill indemnity and insurance arrangements would work as follows:

• Private sector doctors contracting to the NHI would not be indemnified by the State
• State employed doctors who have a PERSAL number are indemnified as set out by the Treasury Regulations of the Public Finances Act as well as the Public Services Act
• Private sector doctors would have to have their own form of indemnity or insurance. 

Crucially, we made it clear that healthcare practitioners need to have certainty over their indemnity arrangements. This is also the case for patients who no doubt wish to be assured that they will continue to have access to compensation should they make a clinical negligence claim against a practitioner.

Clinical negligence is obviously a complex area of healthcare. But it is also an area that is of vital importance to both healthcare practitioners and patients.

While there is a considerable way to go in the development of NHI, it is critical that there is greater clarity from the government about how indemnity and insurance arrangements will work.

Medical Protection is keen to assist the government with this and have offered our wealth of experience and knowledge in this field to ensure that indemnity is addressed and accounted for under the new arrangements.

In the meantime, we will continue to make representations on this issue and work to ensure our members’ interests are factored in to the development of the NHI Bill as it progresses through parliament.