Is racial profiling undermining South African healthcare? A call for accountability and reform
Image: AI / Ron
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.
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.
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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.
It also sought a restitution framework, overseen by the Council for Medical Schemes (CMS), designed to review and remedy individual cases fairly, efficiently, and with a sense of urgency.
'As a union steadfastly committed to justice, equality, and transformation, Hospersa cannot allow this moment to pass without demanding full accountability, restitution, and long-overdue structural reform.
'To ensure that this injustice is never repeated, Hospersa calls for systemic changes across the private healthcare sector. All race-based profiling algorithms must be immediately discontinued and outlawed. Oversight mechanisms must be strengthened to enforce transparency and accountability in audit practices. Affected schemes must implement anti-bias training and submit to regular, independent audits of their fraud detection and disciplinary systems,' said Mdlalose.
The union said the issuance of the findings and recommendations of the Section 59 report 'must serve as a turning point'.
'The Section 59 Report is more than an indictment of past practices, it is a call to action. Racial profiling in the healthcare sector is a betrayal of both ethical norms and constitutional values. It undermines professional dignity and perpetuates racial injustice under the excuse of fraud detection.'
Meanwhile, Discovery Health strongly disagreed with the findings and called on CMS to carefully review the panel's conclusions to prevent harm to medical scheme members and the long-term viability of medical schemes.
Discovery Health CEO, Dr Ron Whelan, said the conclusions from the investigation are 'based on flawed methodology, unscientific assumptions, and misinterpretation of complex data'.
Dr Whelan said they are currently reviewing the report in full and considering their options, including a formal review of the findings, which drew numerous conclusions that, according to Dr Whelan, is not supported by credible evidence.
Discovery Health said: 'No evidence has been presented to support the allegations that (we have) investigated or sanctioned any healthcare professional in a biased or unjustified manner. In fact, the panel's own interim report in 2021 confirmed that the processes used by medical schemes were legally sound and showed no explicit evidence of racial bias.
'Furthermore, all complaints submitted to the Section 59 Panel by healthcare providers against schemes administered by Discovery Health were shown to have legitimate grounds for investigation, with no evidence of racial profiling.'
Gems said over the past three years, since the release of the Interim Section 59 Panel Investigations, they have 'taken comprehensive steps to strengthen its FWA management framework to eliminate any potential for disparate outcomes'.
According to the medical scheme, after the interim report made several recommendations, they have already begun to implement policies which 'largely reflect reforms'.
Gems principal officer, Dr Stanley Moloabi, said: 'It is reassuring that the panel has found no evidence that GEMS acted with racist intent. This distinction is critical - structural outcomes must not be confused with deliberate discrimination.
'(We) will continue to work closely with the CMS, healthcare providers, and members to ensure that our FWA systems are transparent, fair, and compliant to all laws and regulations of the Republic of South Africa.'
Enquiries to Medscheme had not been answered by deadline.
During a portfolio committee meeting held on Friday, Health Minister Aaron Motsoaledi pointed out the 'silence' in the National Health Act regarding remuneration or corrective measures to be taken in cases where discrimination against health professionals is identified.
He also called for algorithm and software transparency in which the department is able to be privy to information regarding risk ratios against black health professionals.
chevon.booysen@inl.co.za
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This distinction is critical - structural outcomes must not be confused with deliberate discrimination. We are committed to continuous improvement, guided by independent oversight of the Council for Medical Schemes (CMS) and shaped by trust," said Gems Principal Officer, Dr Stanley Moloabi. Meanwhile, IOL reported that Discovery Health disagreed with the findings. Discovery Health CEO, Dr Ron Whelan, said the conclusions from the investigation are 'based on flawed methodology, unscientific assumptions, and misinterpretation of complex data'. Healthcare workers union, Health & Other Services Personnel Trade Union of South Africa (Hospersa), condemned the findings, adding that the report had confirmed the suspicions and personal experiences of many black healthcare professionals, IOL reported. 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. 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