Overservicing patients

The Health Professions Council of South Africa’s guidelines on overservicing, perverse incentives, and related matters, or Booklet 5, states: “Health care practitioners shall not provide a service or perform or direct certain procedures to be performed on a patient that are neither indicated nor scientific or have been shown to be ineffective, harmful or inappropriate through evidence based review.”

Overservicing of patients is not new to the healthcare sector and is behaviour that has been noted across disciplines, from general practitioners to dentists and specialists. It is actually fraudulent behaviour without any justification. Over the years, medical schemes have continued to monitor and adjudicate on ambulance services that either provide unnecessary treatment to patients, or charge for ambulance trips to hospital that were not even provided in the first place. These unethical ambulance services are often identified and suspended as providers for the scheme, making it very difficult for them to continue operating their businesses.

It needs to be pointed out that while providing pain control or an antiemetic to a patient who does not require such treatment , usually with a financial reason behind it, one clear example of overservicing, there are even greater excesses that are often applied to patients. Patients can also be overserviced at Basic Life Support level. When a practitioner attends to a patient that has taken a light fall, or has been involved in a minor motor vehicle accident, and the practitioner ‘convinces’ the patient that he or she may have a serious injury that they are not aware of, we have a clear example of overservicing a patient. If a patient simply needs some disinfectant cream and a paracetamol tablet that can be administered at home, that patient does not require the emergency medical services of an ambulance and most definitely does not require treatment in a hospital!

Ambulance services need to be very cautious about overservicing patients at Basic Life Support level, and the tendency of some ambulance services to ‘convince’ patients that they need to go to hospital must stop. Ambulance services and practitioners behaving in such a manner are doing so fraudulently and unethically, and are dragging down the image of the remainder of the industry that is operating ethically and professionally. If ambulance services are seen to be overservicing patients on a regular basis, it also causes medical aid schemes to place more emphasis on clinical adjudication, and to question genuine patient treatment that was actually fully justified and should be paid for accordingly.

Financial incentives above those that are genuinely due are constant temptations that serve to corrupt the medical industry, and pervert the real purpose of healthcare – namely to care for the sick and injured in the most appropriate manner. Let us not forget that code and allow greed to become an overriding factor in our daily behaviour.

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