Abstract
Background: The focus of this research was to explore the perspectives of advanced life support (ALS) providers regarding factors they feel are influencing financial medicine practices in the South African prehospital emergency care environment. Financial medicine in the context of this study is defined as 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.
Aim: To explore and describe the perspectives of advanced life support providers regarding factors that they think may be influencing the practising of financial medicine within the South African prehospital emergency care environment.
Method: A prospective qualitative study design was adopted in which the researcher made use of a number of open-ended one-on-one interviews with a sample of ALS providers. The interviews were audio recorded and transcribed verbatim. The researcher made use of the Atlas.Ti ® software application to assist with the coding of transcripts and the identification of emerging themes.
Results: Financial medicine practices continue to take place in the prehospital environment of South Africa. From the perspective of the participants, the main drivers of financial medicine practices are (a) the linking of the level of care to billing rates, (b) the fact that financial medicine practices are historically entrenched, (c) poor service delivery from public service providers, (d) the offering of perverse incentives and (e) pressure from management to meet company financial targets.
Conclusion: Financial medicine practices (in the SA context) remain pervasive and are clearly unethical. ALS providers working for private ambulance services express feelings of guilt and negativity towards the practising of financial medicine. The main drivers of financial medicine are within the control of the industry. To reduce the incidence of financial medicine practices, attention needs to be given to improving the public health care system, providing better education for practitioners about
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financial medicine practices and revisiting the current billing system and eliminating the offering of perverse incentives to ambulance crews.