Doctors do some soul-searching on kickbacks and perverse incentives

June 26 2000

By Marjolein Harvey

Following last month's media reports on doctors receiving kickbacks from laboratories for unnecessary medical testing, the South African Medical Association (Sama) hosted a work session on Friday to find mechanisms of addressing the problem.

The medical professionals' meeting precedes a summit planned for August involving other stakeholders, such as the Board of Healthcare Funders (BHF), the pharmaceutical industry, hospitals and consumers.

The work session's main aim was to come to a shared understanding of what constituted perverse incentives as opposed to legitimate and acceptable business practices by medical professionals.

"Sama is confident that [doctors receiving kickbacks from laboratories] involves only a minority of doctors," the medical professionals' interest body said in a statement on Monday.

"We have looked at wide-ranging issues that may influence unethical conduct, and in what form they occur [eg financial inducements]," says Sama.

"The participants have asked themselves some soul searching questions like: Do some doctors genuinely struggle to make a living? Is there a lack of moral conscience with the individuals concerned? Is there a deficiency with the training or the values that we instill in our medical education system?"

Key resolutions adopted at the work session were:

• patient interest is paramount under all circumstances
• the profession, through Sama, recommits itself to strengthening the traditional trusting relationship between doctors and patients
• Sama should convene a forum of all stakeholders in healthcare to discuss and take the process further
• the delegates must take the matter back to the membership for further deliberation
• Sama must promote the development of clinical practice guidelines on appropriate medical care by the respective professional groupings
• the Forum of Statutory Health Councils' policy document on perverse incentives is an excellent basis for developing and exploring further action

"We wish to assure the public and patients that the vast majority of medical doctors are ethical and responsible professionals. However we have elected to approach the problem positively, and to make it clear that unethical behaviour is unacceptable."

Sama is concerned that the practice of unethical behaviour among health professionals can quickly become widespread as part of a societal tendency to fraudulent, "grab-and-run" behaviour.

The media has played an important role in bringing this issue into the public domain, but Sama says that this has created a perception that doctors are unethical.

"Such perceptions are not only damaging to our image as a profession, but also detrimental to the health system as a whole," says Sama.

The issue of kickbacks or perverse incentives was also debated at length during a meeting earlier in June of the Association's Private Practice Committee.

The Committee recommended to Sama's Board of Directors that further deliberations should further seek to identify exactly what constituted perverse incentives as opposed to legitimate and acceptable business practices.

The investigation should look at coercion, the role of managed healthcare contracts, the utilisation of medical scheme administration fees, and sponsorships.

Acknowledgement to