Call for reform of med schemes after racial profiling findings

APOLOGIES are necessary, but are not enough; material redress and structural consequences should be the next steps against medical schemes that racially profile black healthcare professionals.

- CHEVON BOOYSEN

Healthcare workers union, Health & Other Services Personnel Trade Union of South Africa (Hospersa), expressed deep concern and condemnation following the announcement of the findings of the Section 59 Investigation Report in which three medical schemes, namely Government Employees Medical Scheme (Gems), Medscheme, and Discovery Health, applied discriminatory risk ratios to black health professionals.

The discrimination affected black healthcare professionals in disciplines such as physiotherapy, psychology, and social work, who are said to be 'more likely' to be guilty of fraud, waste, and abuse (FWA).

The panel reviewed statistical and testimonial evidence, and found that black providers were disproportionately flagged, audited, or penalised through opaque FWA systems.

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.

Hospersa spokesperson, Lindelwa Mdlalose, stated that the report confirmed the suspicions and personal experiences of many black healthcare professionals.

The union called for remuneration and class action litigation against the medical schemes found to have applied such racial profiling, resulting in financial and reputational harm to individuals.

Hospersa stated that the medical schemes should be held accountable and issue formal public apologies.