Report finds racial bias by medical aid schemes
The findings of an investigation into claims that medical aid schemes are racially discriminating against black healthcare providers in South Africa have been released.
The inquiry was conducted by the Section 59 Investigation Panel.
The probe was launched after the National Health Care Professionals Association and Solutionist Thinkers complained in 2019.
Members alleged that schemes were withholding their claims based on their race and ethnicity.
The Health Minister directed the Council for Medical Schemes to establish an independent panel to investigate.
Advocate Tembeka Ngcukaitobi led the three-member panel.
He handed a final report to Health Minister Aaron Motsoaledi on Monday.
" Evidence of the risk ratios before us showed racial discrimination against black service providers by the schemes. And this risk ratio is basically a tool that we developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding, and a penalty versus a white practitioner. And black is a generic term that includes coloureds, Indians, and Africans."
READ: SAMA and Ntuli to meet over attack on doctors
Ngcukaitobi also handed over the findings of an interim report that his team completed in 2021.
He revealed some of their findings from between 2012 and 2019.
" For GEMS, Black dental therapists in 2014 experienced risk ratios of between 2.7 and 3.7. In other words, they were generally approximately three times 300% more likely than non-black dental therapists to be guilty of fraud, waste, and abuse.
"For Discovery, black psychiatrists in 2017 experienced risk ratios of between 3.44 and 3.77. In other words, black psychiatrists were generally approximately three and a half times more likely than non-black psychiatrists to be guilty of fraud, waste, and abuse."
Ngcukaitobi says they also tried to ascertain if the procedure followed by schemes when they implement fraud, waste and abuse inquiries is fair.
"And what we had found in relation to the procedural fairness was that the FWA procedures for the recovery of monies allegedly owed are unfair, and they violate the rights to procedural fairness of individual practitioners."
Find us on social media
Follow the ECR Newswatch WhatsApp channel here
