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Racism, breaking confidentiality & profiling: unpacking the medical aid scheme hearings

BY CEBELIHLE BHENGU - 02 August 2019 - 06:58
Some black, Indian and coloured doctors accuse medical aid schemes of racism. Two doctors told the inquiry that medical aid companies were "out to destroy black professionals".
Some black, Indian and coloured doctors accuse medical aid schemes of racism. Two doctors told the inquiry that medical aid companies were "out to destroy black professionals". 
Image: Shironosov

The Council for Medical Schemes initiated a probe which is hearing testimonies from black, Indian and coloured doctors who have accused medical aid schemes of fraud, intimidation and being forced to break patient-doctor confidentiality, among other things. 


Here's what you need to know:

Racism, delayed or non-payments

The inquiry, headed by advocate Tembeka Ngcukaitobi, heard complaints and scathing allegations by members of the National Health Care Professionals' Association (NHCPA) who accused medical aid companies including Discovery and Medscheme of racial profiling, especially when the companies were required to pay doctors.

The council heard that unlike their white counterparts, black, Indian and coloured doctors are required to share patient's files when claiming for payments, which is illegal as this breaches patient-doctor confidentiality.

Doctors further claimed that due to delayed or non-payments, some doctors have committed suicide, while others have closed shop. The doctors said this does not happen to their white colleagues.

Prior to the start of the inquiry, the South African Human Rights Commission (SAHRC) held a preliminary inquiry which paved way for the hearings now underway. Buang Jones, SAHRC manager, criticised how, among other things, medical schemes did not have the racial demographics of the doctors who were contracted to them.. 

Jones questioned how, with the country's history of racial segregation, the companies did not have this information in their databases. This followed Discovery Health CEO Jonathan Broomberg's submission to the commission that the company did not know the gender and/or race of the professionals contracted to the scheme.

Jonas said this was disappointing as the provision of such details would have been helpful for the commission.

"It's really disappointing that Discovery doesn't see it as important to have a demographic profile of health-care practitioners who are part of their network so that as the commission we get to understand how many practitioners are benefiting from this network."

Unlawful fraud probes 

NHCPA's Dr Donald Gumede and Dr Thandi Mkhize told the SAHRC that medical aid companies were "out to destroy black professionals", and claimed that the companies unlawfully hired private investigators to pose as patients to spy on them.

Broomberg described the allegations as "wild and unfounded", saying the company would neither confirm nor refute the "opinions" of the doctors.

Hearing, final report

The panel will hear the submissions by the doctors until September and is set to release the final report on November 1.