Medical malpractice is becoming costly, with litigation costs ranging from 2%-10% of total healthcare spending. Obstetrics is under particular scrutiny as amongst the highest litigation settlements. Specialists perceived as being under higher liability risks are likely to practice ‘defensive’ medicine, leading to an increase in unnecessary clinical procedures.  

In South Africa, several high profile cases of litigation have led to national and provincial efforts to reduce litigation in obstetrics. To inform this process, the WHO Country Office in close collaboration with AFRO and HQ commissioned a review to identify medical malpractice models in obstetrical procedures globally. 

The review identified the following initiatives:

1.     No-fault approach (includes strategies when medical injuries are compensated without proof of fault)

2.     Safety program and practice guidelines (includes strategies for reduction and mitigation of unsafe acts within the healthcare system, and the use of best practices shown to lead to optimal patient outcomes)

3.     Specialized courts and alternative claim resolution (includes an alternative to judicial courts (i.e. specialized health courts or administrative models) for handling medical malpractice claims that are characterized by the use of specially trained adjudicators, independent expert witnesses, and predictable damage awards) 

4.     Communication and resolution (includes strategies that involve communication between physician and patient outside the court-room setting to reach a mutual agreement on dispute and fair compensation)

5.     Caps on compensation and attorney fees (includes strategies that limit the amount of non-economic or punitive damages that may be awarded for a case)

6.     Alternative payment system and liabilities (includes strategies that reduce the burden of liability pressure and financial burden of claims payment)

7.     Limitations on litigation (includes strategies that limit the type and amount of medical malpractice claims entering the system)

8.     Multi-component models (e.g. includes multiple components of the above) 

The review is currently being studied by a national task team for dissemination to provinces. Click here for a full report