Damning report confirms racial bias by SA medical aid schemes
The findings were handed over to Health Minister Dr Aaron Motsoaledi on Monday by panel chair Advocate Tembeka Ngcukaitobi.
The independent inquiry was established following complaints lodged in 2019 by the National Health Care Professionals Association and Solutionist Thinkers, who alleged that claims by black practitioners were disproportionately withheld or scrutinised based on race and ethnicity.
Ngcukaitobi confirmed that the panel found compelling evidence of systemic racial bias.
'Evidence of the risk ratios before us showed racial discrimination against black service providers by the schemes,' he said.
'Black is a generic term that includes Coloureds, Indians, and Africans.'
Using a statistical tool called a risk ratio, the panel measured the likelihood of black practitioners being subjected to investigations and penalties compared to their Wwhite counterparts. At GEMS (Government Employees Medical Scheme) in 2014, Black dental therapists were 2.7 to 3.7 times more likely to be found guilty of fraud, waste, and abuse (FWA).
(Government Employees Medical Scheme) in 2014, were to be found guilty of fraud, waste, and abuse (FWA). At Discovery Health in 2017, Black psychiatrists were 3.44 to 3.77 times more likely to be penalised than non-Black psychiatrists.
These ratios translate to a 300-370% higher likelihood of black professionals being implicated in FWA cases.
Beyond the racial disparity, the investigation also found that the procedures used by schemes in FWA inquiries lacked fairness and transparency.
'The FWA procedures for the recovery of monies allegedly owed are unfair, and they violate the rights to procedural fairness of individual practitioners,' said Ngcukaitobi.
An interim report was previously submitted in 2021, but the final findings now confirm what many in the medical community have long argued – that black healthcare providers face disproportionate scrutiny under the current medical aid system.
The release of the report is expected to prompt renewed calls for reform within the medical aid sector.
Stakeholders are now awaiting the Health Minister's response and potential recommendations for systemic changes.
The findings raise serious questions about equity, transparency, and accountability within South Africa's private healthcare administration.
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