Medical schemes face scrutiny over racial discrimination against black health professionals
Image: GCIS
There must be consequences and punitive measures, which include back payments by medical schemes, that were found to have applied systemic discrimination against black health professionals when they applied risk ratios against them.
This call has come after the findings of a Section 59 investigation report revealed that three medical schemes, namely GEMS, Medscheme, and Discovery, applied discriminatory risk ratios to black health professionals, in disciplines such as physiotherapy, psychology, and social work, who are 'more likely' to be guilty of fraud, waste, and abuse.
It is unclear how many medical professionals were affected by racial profiling and how many lost their business practices.
The investigation was launched in 2019 after several healthcare providers made allegations that they were being unfairly treated by medical aid schemes based on race and ethnicity. The affected section relates to the payment of claims by black medical professionals.
Video Player is loading.
Play Video
Play
Unmute
Current Time
0:00
/
Duration
-:-
Loaded :
0%
Stream Type LIVE
Seek to live, currently behind live
LIVE
Remaining Time
-
0:00
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
Text Color White Black Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Transparent Semi-Transparent Opaque
Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps
Reset
restore all settings to the default values Done
Close Modal Dialog
End of dialog window.
Advertisement
Video Player is loading.
Play Video
Play
Unmute
Current Time
0:00
/
Duration
-:-
Loaded :
0%
Stream Type LIVE
Seek to live, currently behind live
LIVE
Remaining Time
-
0:00
This is a modal window.
Beginning of dialog window. Escape will cancel and close the window.
Text Color White Black Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan
Transparency Transparent Semi-Transparent Opaque
Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps
Reset
restore all settings to the default values Done
Close Modal Dialog
End of dialog window.
Next
Stay
Close ✕
However, in the absence of remuneration guidelines by the National Health Act, Health Minister Aaron Motsoaledi, during a portfolio committee meeting on Friday, said they will seek legal advice on the matter.
The findings of the report raised questions during the meeting about equity within the profession, igniting discussions about fairness, accountability, and restitution.
Motsoaledi said the Act does not indicate what steps should be taken, and currently, it appears the medical schemes decide their measures.
'This is a statutory matter due to the silence in the Act. It does not indicate the steps that the schemes must take when they investigate such a fraud. That is the weakness picked up by the panel, and the Act itself does not provide guidance on what should be done.
'The medical schemes have decided to divulge their methods, which were unfortunately tampered with by racial bias. Even if the Act does not outline what must be done, whatever is done in a new South Africa governed by democracy cannot be informed by racial profiling. We will have to look into that,' said Motsoaledi.
The minister said the members of Parliament are 'not mere bystanders and observers', and have an onus on them to have the Act amended to speak specifically to such reform.
Motsoaledi said they are still studying the report, and legal advice is being sought after its release on Monday.
Chairperson for the Council for Medical Schemes (CMS), Dr Thandi Mabeba, said the council will have a special sitting next Monday to interrogate the findings, recommendations, and the implications of such recommendations.
Dr Mabeba said they would also hold engagements across the industry, including the steering committee. 'The minister has alluded to the report, which has damning findings, and as such, we need to apply our minds in ensuring that we guide the industry in a manner that is legally and in line with our statutory mandate.'
On Monday, chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, welcomed the findings of the Section 59 investigation panel.
'The report paints a concerning picture of the disproportionate impact that medical schemes' fraud, waste, and abuse systems have had on black healthcare providers…These findings are deeply troubling and point to systemic flaws in the design and implementation of the fraud, waste, and abuse systems.
'It is unacceptable that black healthcare providers have been subjected to such blatantly discriminatory treatment, which has undoubtedly had a devastating impact on their livelihoods and the communities they serve.
'We cannot allow such systemic discrimination to continue unchecked, as it undermines the transformation of the healthcare sector and the constitutional right to equality,' said Dr Dhlomo.
chevon.booysen@inl.co.za
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
IOL News
a day ago
- IOL News
Health Minister reveals lack of mechanism to reclaim treatment costs for undocumented migrants
Health Minister Aaron Motsoaledi says there is currently no mechanism for the provincial health departments to recover the costs from the countries of origins for all immigrants if their accounts remain unpaid Image: Parliament of SA The provincial health departments lack a mechanism to reclaim unpaid costs incurred for treating migrants in the public health facilities from their countries of origin. This was revealed by Health minister Aaron Motsoaledi in response to parliamentary questions posed by EFF MP Nqobile Mhlongo. Mhlongo asked about the expenditure by provincial health departments on emergency and/or triage healthcare for undocumented migrants in the 2024/25 financial year. 'Currently there is no mechanism for the provincial departments of health to recover the costs from the countries of origins for all immigrants if their accounts remain unpaid,' Motsoaledi said. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Next Stay Close ✕ Motsoaledi also said the departments do not segregate any data related to documented and undocumented migrants. 'The department is working on finalising the Integrated Disease Surveillance and Response Strategy, which aims at strengthening surveillance systems including improvements on collection of data about nationality, irrespective of the legal status of clients in the country,' he said when asked about the number of public health facilities that exceeded capacity due to migrant patient volumes. Motsoaledi explained that the National Health Insurance Act provides that nobody may be refused emergency medical treatment in line with the Constitution. 'Section 27(1) of the Constitution provides that everyone has the right to have access to health care services within the state's available resources. Section 4 of the NHIA mandates who will be required to pay for elements of their health care. It does not exclude anyone from accessing healthcare,' he said. Motsoaledi's response comes amid ActionSA slamming the department for not keeping track of nationalities of patients treated in public healthcare facilities. Activists from Operation Dudula have until recently attempted to turn away foreign nationals seeking treatment at public health facilities. Responding to ActionSA MP Kgosi Letlape, the minister cited the Constitution which provides that everyone has the right to access healthcare services, including reproductive healthcare, and that no one may be refused emergency medical treatment. 'Health care is provided based on clinical need, not on nationality or documentation status," he said. However, Letlape said in the absence of tracking, verification or appropriate data collection, the department was unable to account for the full scope of service delivery liabilities. 'We believe that this is particularly concerning given that millions of foreign nationals, many of whom are undocumented or lack any form of medical insurance, reasonably make use of taxpayer-funded public healthcare services. 'In a public health system already buckling under pressure, with overcrowded hospitals, long queues, understaffing and medicine shortages, this lack of oversight is reckless and unsustainable.' Letlape also said the absence of patient categorisation severely compromises effective planning, budgeting, and policy formulation. 'This is further compounded by the lack of any identification or status verification mechanism, which means patients are not required to present identification, preventing healthcare providers from verifying legal status or maintaining accurate and continuous patient records,' he said. Motsoaledi clarified that the country's health system was under pressure due to several factors that included but were not limited to budget cuts, infrastructure challenges and human resources constraints. The clarification was a response to EFF MP Chumani Matiwane who asked whether he has found that the ongoing crisis in the public healthcare system stemmed primarily from structural under-investment, maladministration and systemic weaknesses, rather than the treatment of foreign nationals. He was also asked about steps his department has taken to ensure that healthcare access remained non-discriminatory amid the increasing public pressure and demonstrations targeting foreign nationals in public healthcare facilities. Motsoaledi stated that it was only the Department of Home Affairs, which has the ability to know whether a person is legal or not in the country. 'However, we do not refer patients to Home Affairs, but we can report that provincial Departments of Health and health facilities have reported a high number of undocumented patients accessing health services. As we have stated above, we do not legally know the nationalities of such undocumented patients.' Motsoaledi also said his department and all their health facilities never stopped anybody from entering facilities and accessing healthcare services.
IOL News
3 days ago
- IOL News
Gauteng healthcare workers unite for Gaza amid worsening humanitarian crisis
Scores of healthcare workers from some of Gauteng's largest hospitals participated in lunchtime pickets on Thursday, standing in solidarity with the beleaguered people of Palestine. Image: Itumeleng English / Independent Newspapers Scores of healthcare workers across some of the biggest hospitals in Gauteng participated in lunchtime pickets as they stood in solidarity with the people of Palestine. The pickets, part of the Healthcare Workers for Palestine, have indicated that the public health crisis in Gaza continues to worsen, with increasing attacks on hospitals and healthcare facilities. According to media reports, Gaza's already compromised healthcare system is in a state of collapse, with blood banks reported to be running dry while Israeli forces continue targeting clinics and facilities housing patients and displaced families. Al Jazeera reports that healthcare officials in parts of Gaza have been besieged, resulting in a severe shortage of blood as many would-be donors are too malnourished to help due to an Israeli-induced hunger crisis that has so far claimed the lives of 193 Palestinians, including five in the past 48 hours. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Next Stay Close ✕ Speaking outside the Chris Hani Baragwanath Academic Hospital, Muzzammil Tayob, a 5th-year medical student, said it is important for the world, including South Africans, to show their solidarity with the victims of genocide who are dying in their numbers in Gaza. "We are here to show our solidarity with the people of Palestine. With the humanitarian crisis currently under way in Gaza, the situation is dire, with many describing it as being at a point of no return. What we are calling for is aid and entry of the healthcare team, the end of the blockade, and ultimately the dismantling of the Israeli apartheid regime in Palestine," he stated. In Gauteng, these lunchtime pickets also took place outside other hospitals, including Rahima Moosa, Charlotte Maxeke Academic, as well as outside some of the hospitals in the Western Cape, as healthcare workers called for an end to the genocide and humanitarian crisis. Recent reports indicate that more than three months of relentless shelling and fighting have pushed Gaza's hospitals to the brink of collapse, creating a spiralling crisis of preventable deaths and permanent injury that is piling tragedy on top of the war's skyrocketing death toll, currently over 24,000, according to the Gaza Health Ministry. Nazreena Hassim, speaking on behalf of Healthcare Workers for Palestine in SA, said the country's healthcare professionals are deeply disturbed by the deliberate denial of food, water, and medical aid to a besieged population. "We demand an end to this inhumane assault on life and dignity, and we urge the international community to act with urgency. We will not stay silent as our counterparts in Gaza face unspeakable conditions. Our oath to protect life knows no borders. We also remind fellow South Africans of the parallels we face. "While Gaza starves from Israel's Weaponisation of Hunger, many South Africans go to sleep on an empty stomach, too. As healthcare workers, we cannot bear witness to Gaza without reflecting on the plight of South Africa's most vulnerable here at home," Hassim said. Another healthcare worker, who did not want to be named, called on other healthcare workers and ordinary South Africans to join in raising the alarm over the humanitarian crisis in Palestine. "We encourage other healthcare workers and our colleagues, including ordinary South Africans, to lend their voice in this fight against outright human oppression that is taking place in Gaza. It is disheartening to see children suffering under the cruelty of the Israeli regime," she stated.
IOL News
3 days ago
- IOL News
Lying idle at Durban's Wentworth Hospital is a batch of donated diesel generators
Health Minister Aaron Motsoaledi says electrical engineers have advised that consignment of diesel-powered generators received by Minister of Electricity Kgosientsho Ramokgopa (pictured) were not suitable for installation against existing electrical reticulation as they will immediately fail at commissioning. Image: File LOW VOLTAGE More than 300 low-voltage diesel generators shipped from China are currently stored unused at a Durban hospital in KwaZulu-Natal, pending distribution to provinces. This was revealed by Health Minister Aaron Motsoaledi when he was responding to parliamentary questions from Rise Mzansi leader and MP Songezo Zibi, who brought up concerns regarding the KwaZulu-Natal Department of Health seeking additional funding to procure new generators while the donated ones were disused. The donated generators were part of the consignment received by Electricity and Energy Minister Kgosientsho Ramokgopa in November 2023 and August 2024 after they arrived at the Durban harbour. They were meant to be used to alleviate the impact of load shedding in the delivery of services in clinics, schools and courts whilst government continued to implement the Energy Action Plan. Zibi noted that the KwaZulu-Natal Department of Health had received a donation of about 100 generators from the People's Republic of China to assist clinics and hospitals during inclement weather and loadshedding. 'The generators remain unused and stored at the Wentworth Hospital in Durban, amidst raising concerns about financial mismanagement,' he said. Zibi also said the provincial department continued to seek additional funding to purchase new generators while the donated generators lay idle. 'What are the reasons that the donated generators have not been distributed and/or or utilised and is their total estimated monetary value,' he asked. In his written response Motsoaledi said the KZN Department of Health did not receive a donation of 100 generators of varying capacities from the People's Republic of China, but only 22 generators. He said the donation was facilitated through a deal between the Ministry of the Department of Electricity and Energy and the People's Republic of China, with a total of 328 generators earmarked for the health sector inclusive of all provinces in the country. 'The reason why these generators were stored at Wentworth Hospital in KZN, was for convenience as the point of entry was the Durban harbour, and the hospital provided the needed space for storage.' Motsoaledi also said the generators have not been distributed to other provinces due to the size of generators donated from China, which was less than 6 KiloVolt-Amperes (KVA). This was despite the minimum KVA requirement for a small size clinic being 20 KVA. 'The electrical engineers advised that these generators were not suitable for installation against existing electrical reticulation as they will immediately fail at commissioning,' he said. Motsoaledi said the generators allocated to the health sector were estimated at R3 million out of a total value of approximately R160 million for the generators donated by People's Republic of China for all sectors of government. He confirmed that KZN purchased 494 generators to the tune of R297.8m over the past three years. 'The purchasing of generators by the KZN Department of Health was necessary to respond to backup power needs at health facilities, especially with the ongoing loadshedding and load reduction measures being implemented by Eskom. 'The unused stock is meant to be used by other provinces, as the KZN Department of Health stock is not part of the generators stored at Wentworth Hospital,' he said, adding that KZNl allocated their allotment of 22 generators from the donation to their disaster management unit. Motsoaledi stated that while the powers to institute any consequence management in the province rested with the Premier and the Heads of Department, none has taken place because no official ordered the specific generators. 'They were donated in kind,' he said. 'The national Department of Health is liaising with The Department of Electricity and Energy to facilitate a potential reallocation of the generators to a sector where they will be fit for purpose,' said Motsoaledi.
