Strategic Objectives

Perverse Incentives

PERVERSE INCENTIVES

Council wishes to draw the profession’s attention to its adopted policy pertaining to perverse incentives and request that it is read with Rule 6 of the rules.

A practitioner should at all times act in the best interest of the patient and place the clinical need of the patient paramount. To this end a practitioner should always maintain professional autonomy, independence, and commitment to the appropriate professional and ethical norms. Any incentive or form of inducement which threatens such autonomy, independence, or commitment to the appropriate professional and ethical norms or which does not accord first priority to the clinical need of a patient, is unacceptable.

The policy statement applies to veterinarians in the public sector and those in the private sector who are contracted to provide services in the public sector. Examples in this sector are inter alia : over servicing patients and unnecessary referral to private practitioners; falsifying claims in order to increase statistics and selling drugs to private clients. It would be an offense to both offer an inducement and to accept it.

For the purpose of this policy statement the following words will have the meanings as indicated:

Valuable Consideration: the offer or acceptance of rewards, gifts or incentives to encourage sales or usage.

Trade: an act or an instance of buying and selling goods and services for financial gain.

Market related rental: as explained under note 8 of this policy statement.

Veterinarians may be involved for commercial purposes to trade in animal pharmaceuticals, feed and commodity products which form an integral and essential part of most practices. The supply of animal health products by veterinarians potentially adds important clinical value to these products. These aspects must be viewed as an integral part of the scope of practice of veterinarians. Veterinarians are in the best position to supply veterinary medicines and information regarding the rational use of essential veterinary medicines to developing farming communities;

Veterinarians may advertise the availability of veterinary and animal related products at veterinary practices. Income generated from the sale of these products by veterinarians are regarded as essential for the maintenance of many veterinary practices;

It is not permissible for a veterinary practitioner to engage in or advocate the preferential use of or prescribe any veterinary service or medicine or any product such as infant feeding products, vitamin supplements and products relating to weight control if any valuable consideration such as educational policies for a practitioner’s family, subsidized training (local or international), insurance policies, retirement annuities, or motor vehicle schemes is derived from such preferential use or prescription;

Veterinarians may refer patients to a registered veterinary facility, his / her own registered facility or to a registered member of the profession or to any health facility or institution e.g. (X-ray facilities, Cath lab, Path lab etc. only

If no valuable consideration is derived from such referral such as education policies for a practitioner’s family, subsidized training (local or inter national), insurance policies, retirement annuities, or motor vehicle schemes.

If no valuable consideration is derived from the referral of a patient to a specific practitioner or specialist (This does not include referral to facilities in which veterinarians have a financial interest as veterinarians own and practice from their veterinary clinics and hospitals which they are allowed to advertise.;)

It is not permissible for a veterinarian to permit or allow any immediate family member to own shares in any non-listed company which is involved in the manufacture of any medical device or medicine or any product such as infant feeding products, vitamin supplements and products relating to weight control;

It is not permissible for a veterinarian to permit or allow any members of the immediate family to own shares in any veterinary facility or veterinary service unless such facility or service operates as a listed company;

It is permissible for a veterinarian to own shares in a non-listed company or have a financial interest in an entity which owns or manages veterinary facilities or veterinary services or which manufactures, markets or distributes any veterinary devices, veterinary medicines or any products such as infant feeding products, vitamin supplements and products relating to weight control;

It is not permissible for a veterinarian to pay rentals in lease agreement which are not market related or accept payment or part-payment of room rental from such facilities. Market related rental is difficult to define.. A veterinary facility or veterinary service may wish to rent its consulting rooms at a particular rate. Such rental must, however, not be conditional on the practitioner to achieve a certain turnover, nor may it be selectively applied. All practitioners working in the veterinary facility must pay the same rental per m² ;

It is not permissible for a veterinarian to accept commission or any valuable consideration from any service in return for the purchase, sale or supply of any goods, substances or materials used by the practitioner in his or her practice or to pay commission or render any valuable consideration to any person for recommending patients;

Clients may be referred for the use of their animals for participating in drug trials, however no valuable consideration may be derived there from;

The veterinarian may not receive any valuable consideration for seeing a veterinary medical representative;

The veterinarian may not enter into a contract to work in a particular veterinary facility or veterinary service on the understanding that a practitioner generates a particular amount of revenue for such facility or service. A facility wherefrom a veterinary service is provided and equips a theatre, ward, etc. for a specific practitioner according to his / her specifications may well enter into a contractual agreement with such practitioner on the condition that such facility or service may not stipulate in the contractual agreement any turnover targets for the veterinary practitioner concerned;

The veterinary practitioner may not share fees with any person or practitioner who has not taken a commensurate part in the service for which the fees are charged; and

The veterinarian may not charge or receive fees for services not personally rendered, except for services rendered by another practitioner or person registered in terms of the Veterinary Act , with whom the practitioner is associated as a partner, shareholder or locum tenens.

his document has been adopted for the Veterinary Profession from the proposed policy statement of the Forum of Statutory Health Councils.

(Published -June 1999)

Perverse Incentives

Veterinarians who:

 

Over service patients;

Refer patients to private practitioners when treatment is not indicated;

Falsify claims in order to increase statistics and sell drugs to private clients;

Advocate the preferential use of or prescribe any veterinary service or medicine or any product and any valuable consideration is derived from such preferential use or prescription;

Pay or offer any commission to any person or colleague as a consideration for clients which are referred to you;

Accept any fee for the examination of an animal from both the buyer and the seller; and

Share fees with any person or practitioner who has not taken a commensurate part in the service for which the fees are charged.

Are jeopardising the autonomy, independence, or commitment to the professional and ethical norms becoming of the veterinary profession.

Any incentive or form of inducement which does not accord first priority to the clinical need of a patient is unacceptable and should be refrained from.

(Published - December 2000)