Medical Schemes in South Africa Accused of Racial Discrimination

The Board of Healthcare Funders (BHF) has rejected the long-awaited Section 59 report, which found alleged racial bias and discrimination by medical aid schemes against black health professionals. The report, presented by Advocate Tembeka Ngcukaitobi, found systemic procedural unfairness and a deeply entrenched power imbalance that has disproportionately impacted black medical professionals. The inquiry, launched in 2019, scrutinised practices by schemes such as Discovery, Medscheme, and GEMS between 2012 and 2019.

Key Takeaways:

The Section 59 report found systemic procedural unfairness and a deeply entrenched power imbalance in medical aid schemes that have disproportionately impacted black medical professionals.
The report found that black practitioners are significantly more likely to be flagged, investigated, and penalised compared to their white counterparts, with risk ratios as high as 6.5 times more likely to be found guilty of fraud, waste, and abuse.
The BHF has firmly rejected the findings of the report, stating that the findings are demonstrably and fundamentally flawed and will open the door for runaway fraud and corruption in the healthcare sector.
Medical aid schemes cost South Africa's medical schemes around R30 billion each year through fraudulent claims, over-servicing, abuse of benefits, and improper billing practices.
These losses directly impact the contributions and benefits of 9.7 million scheme members, the majority of whom come from historically disadvantaged communities.

Statistics:

9.7 million scheme members are impacted by losses due to fraudulent claims, over-servicing, abuse of benefits, and improper billing practices.
R30 billion is lost by medical schemes each year due to these practices.
Black practitioners are up to 6.5 times more likely to be found guilty of fraud, waste, and abuse compared to their white counterparts.

Sources:

Narrated report of the final Section 59 investigation provided by Advocate Tembeka Ngcukaitobi
Statement by the Board of Healthcare Funders (BHF)
Written submissions by Solutionist Thinkers and the NHCPA (National Health Care Professionals Association)
Study of the Section 59 report by NHCPA