Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

BackgroundThe term “financial medicine” refers to the delivery of health-related services where the generation of financial gain or “profit” takes precedence over the provision of care that is reflective of evidence-based best practice. The practicing of financial medicine includes over-servicing and overbilling, both of which have led to a sharp rise in the cost of health care and medical insurance in South Africa. For this reason, the practicing of financial medicine has been widely condemned both internationally and locally by the Health Professions Council of South Africa (HPCSA) and allied Professional bodies.ObjectivesThis qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment.MethodA sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment.ResultsIt emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting.ConclusionThe results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

OpsommingAgtergrondDie term “finansiële medisyne” verwys na die lewering van gesondheids-verwante dienste waar die skep van finansiële gewin voorkeur geniet bo die lewering van sorg soos vereis word deur bewys gebaseerde praktyk. Die be-oefening van finansiële medisyne sluit oor-verskaffing van dienste en oor-fakturering in, wat beide lei tot ‘n skerp styging in gesondheidsorg kostes en mediese versekering in Suid Afrika. As gevolg van hierdie rede word die be-oefening van finansiële medisyne wyd gekritiseer, beide internasionaal en nasionaal deur die “Health Professions Council of South Africa (HPCSA)” en verwante professionele rade.DoelHierdie ondersoekende studie poog om die ondervindinge van Suid Afrikaanse Paramedisie te verken en te beskryf met betrekking tot die gebruik van finansiële medisyne in die plaaslike pre hospitalisasie noodgeval omgewing.MetodeSes Suid Afrikaanse Paramedisie is ondervra om hul ondervindings te ondersoek, te dokumenteer en te beskryf met betrekking tot die praktyk van finansiële medisyne in die plaaslike voor-hospitaal omgewing.Resultate: Dit blyk dat al die deelnemers ‘n aantal finansiële medisyne praktyke ervaar het asook geassosieërde onetiese gedrag. Voorbeelde sluit in: oor-dienslewering; selektiewe pasiënt behandeling, bedrog ten opsigte van eise, aanduiding van onwettige winsbetaling of winsdeling, aansporing of voordele en doelbewuste mors van tyd.GevolgtrekkingDie uitslag van hierdie studie is kommerwekkend omdat die aksies van die diensverskaffers soos beskryf is deur die deelnemers dui op growwe oortredings van die etiese en professionele riglyne vir die professie. Die outeur beveel verdere addisionele studies aan vir uitbreiding van hierdie bevindinge en om die redes vir en maniere van finansiële medisyne praktyke in die plaaslike noodsorg professie te beperk.