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Unforeseen ethical/legal complications with screening tests in the capitation model of medical aid schemes

Rita-Marie Jansen, Chris Gouws, Teuns Verschoor

Abstract


In the South African health care system patients/consumers are divided into those who can afford private care and those who rely on state medical assistance. The system is under pressure to fund delivery of medical care to its beneficiaries. We consider the effects of different funding models on medicolegal liability of health professionals serving the private sector. Medical reasons should determine the service rendered. However, financial implications of services rendered and defensive practice of medicine also contribute to treatment received by a patient and its remuneration. Practitioners who commit to delivering a predetermined set of services within a particular time for a predetermined ‘lump sum’ are only paid for the service specifically requested. Should disease be found other than those contracted for, we argue that inaction with regard to that disease would be deemed to be negligent or unethical according to legal and ethical considerations.

Authors' affiliations

Rita-Marie Jansen, Department of Private Law, University of the Free State, Bloemfontein

Chris Gouws, Horizon Eye Care Centre, Hospital Park, Bloemfontein

Teuns Verschoor, Vice-Rector, University of the Free State, Bloemfontein

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Keywords

ethical/legal, screening tests, capitation model

Cite this article

South African Medical Journal 2012;102(10):787-789. DOI:10.7196/SAMJ.5825

Article History

Date submitted: 2012-03-13
Date published: 2012-09-05

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