Soaring payouts for medical negligence claims against the state pose such a threat to health-care provision that government is proposing a "new pay as you go" system to compensate victims. The idea is that this would spread out its liabilities, but critics say the proposals, contained in draft legislation, are badly framed and may force patients back to the very facilities that harmed them in the first place. The scale of the medico-legal claims is staggering. By the end of the 2016-2017 fiscal year, government faced contingent liabilities — the cost if all claims were successful — of R56.1bn. That equates to almost a third of the R170.9bn consolidated health budget for 2016-2017. The limited figures currently available for the 2017-2018 year suggest the picture has only got worse. The Eastern Cape health department’s contingent liabilities rose from R16.8bn in 2016-2017 to R24.3bn in 2017-2018, it revealed in parliament in May. In Gauteng, the figure rose from R17.8bn to R22bn over...

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