The National Treasury has unveiled plans aimed at curbing soaring medical malpractice claims and litigation hovering at R100 billion.
In a Budget Review, the National Treasury said claims had increased rapidly.
"Although in many cases the quality of care is insufficient, the increase in claims is inconsistent with certain indicators of health outcomes in the public sector," the report reads.
It cites, for example, how the overall death rate in public hospitals declined from 5.4% in 2013/14 to 4.6% in 2018/19. Maternal mortality in facilities decreased by 20.5% over the same period.
However, since 2014, contingent liabilities and payments of medico-legal claims in the public sector have increased at an average annual growth rate of 30% and 23% respectively. In 2018/19, medico-legal contingent liabilities reached R99.2 billion, while medico-legal claim payments reached R2 billion.
"These payments are affecting the budgets of public facilities and, in turn, the delivery of services," the report states.
"Due to large lump-sum payments often awarded in malpractice cases, the effects are unplanned."
The National Treasury said this is a multifaceted problem caused by inadequate quality of care, weak capacity in provincial medico-legal teams, poor administration of medical records, and high profitability for law firms specialising in this area. The report said government now aims to stabilise its liability through a range of interventions and has made progress in several areas.
These include funding reprioritised in the Department of Health's budget to pilot the National Quality Health Improvement Plan in 2020/21.
The department has also contracted law firms with medico-legal expertise to support claim management and provide legal services in some provinces.
"Several provinces are strengthening provincial medico-legal teams, including by contracting external legal capacity," reveals the report.
Parliament is also considering the State Liability Amendment Bill, which would introduce periodic payments and provide for compensation in kind, in the form of future medical care in public facilities. The intervention also sees the Special Investigating Unit probe potential fraud in this area, which has resulted in several arrests.
The department said the effect of these interventions on state contingent liabilities still needs to be evaluated. Long-term solutions may require wider legal reform, which the South African Law Reform Commission is exploring.