medical aid schemes

EFF blasts medical aid schemes for ‘Nazi-like profiling’

Andile Sicetsha - 19.01.2021

The report found that medical aid schemes use an algorithmic system that automatically flags black SA medical professionals as high-risk fraudsters.

In a momentous decision, the Pretoria High Court dismissed an 11th-hour appeal to block the release of an interim report that proves racial discrimination exists in South Africa’s medical aid schemes.

What is the Section 59 interim report about?

This gave way for EFF-aligned Advocate Tembeka Ngcukaitobi and the Section 59 investigative panel to publish its interim report into racial discrimination by medical aid schemes against black healthcare providers.

The inquiry was formed in 2019, after a group of medical professionals approached the Council for Medical Schemes (CMS) with claims that “they were being treated unfairly by medical aid schemes based on race and ethnicity.”

Who’s the worst of the evils?

The report looked into the risk management process of South Africa’s Big Three schemes: Discovery, Medscheme and GEMS. Particularly, the panel zoned in on the schemes’ fraud, waste and abuse (FWA) system.

“We also appointed two further experts: Advocate Wim Trengove SC and Professor Melissa Steyn who provided assistance to the panel with regard to the legal framework to test their unfair discrimination and the principles of implicit racial bias,” the report summary reads.

In its findings, the inquiry concluded that between 2012 and 2019, “black practitioners were more likely to be found to have committed FWA than their non-black counterparts.”

This observation was found in an analysis conducted on all three of the major medical aid schemes listed above.

“This means, for the reasons provided in this interim report, there was unfair racial discrimination,” the inquiry noted.

From an analytics perspective (the period observed was January 2012 – January 2019), these are the report’s findings on a black medical professional’s (across all disciplines) odds of being flagged by the FWA system:

  • black general practitioners are 1.5 times more likely to be identified as FWA cases than their non-Black counterparts;
  • the rate at which Black physiotherapists are identified as FWA cases is almost double (1.87) that of their non-Black counterparts;
  • black psychologists are three times more likely to be identified as FWA cases;
  • more than 50% of black registered counsellors have been identified as FWA cases – the highest rate among the disciplines analysed; and
  • black dieticians are 2.5 times more likely to be identified as FWA cases.

Moreover, Medscheme came out as the most racially discriminatory medical aid scheme with a 330% likelihood of profiling black medical professionals. Government-owned GEMS ranked second with 80% and Discovery trailed in at last place with a 35% likelihood of profiling black practitioners.

EFF takes aim at ‘Nazi-like profiling’ medical schemes

In a statement, the EFF expressed its disappointment in what the data suggests about the government-owned medicals scheme.

“It certifies our belief that South African government has no interest in the development of black professionalsand transforming the sector, and acts as an agent of the deliberate victimisation of black people,” the

The party expects the CMS to bring restorative justice to every black medical professional that has been affected by the “Nazi-like profiling.”