Profiling methods used by medical aid schemes are unethical
RECENT reports of racial profiling and discrimination against black and Indian doctors by medical schemes and their investigation units have finally been revealed to the public.
Doctors have known this and experienced the heavy handedness and bullying tactics for years, but because it was done on a one-on-one basis, the pieces of this puzzle were not put together.
Doctors depend on direct payment from the schemes because the vast majority of patients served by doctors who work in the low socio-economic strata and previously disadvantaged communities don’t have credit cards and cannot afford to pay them directly.
Maybe in the suburbs patients are able to pay, get receipts and claim back, but the poorer patients don’t have the money, nor do they have the resources to send receipts and invoices to medical aid schemes and wait for two or three weeks to get reimbursed.
Therefore, the direct payment system to doctors is convenient for both.
A very common bullying tactic that they use is to approach members of their scheme at their workplaces and ask them questions, intimidate them and very often these patients are not told why they are being questioned and are then given forms to sign.
Patients are expected to recall dates, and services in the past, within a few minutes, and under pressure and duress from the officialdom of the medical schemes and the “investigators”.
The members or patients are not told the true purpose of the questioning nor of the implication of the documents they sign.
Many of their rights are being violated without them even knowing it.
They don’t know what they are signing, they are never given copies of their forms that they have signed and then these statements are used to intimidate and bully doctors.
Often these schemes and their investigators want to use consultation rates and statistics from the leafy suburbs and transpose that data on practices servicing poor people.
Often the boards of many of these schemes are made up of engineers and actuaries, and a few doctors who come from the leafy suburbs and who have never worked with poor people, so their idea of disease patterns and consultation rates etc, is out of touch with the reality in poorer communities.
The direct payment leverage is abused by the schemes to intimidate and virtually blackmail doctors to reveal confidential patient information without the patients’ consent or knowledge.
The minister of health must get medical schemes to release figures of the racial proportions of the doctors they have targeted and investigated.
Let’s see how many white firms of investigators are used by schemes to enforce the racial profiling and discrimination.
No one condones or excuses fraud, but the profiling and methods used by the schemes are highly unethical, unlawful and now have the racial profiling component too.
The minister of health, civil society bodies and various political parties need to take this up and do urgent investigations.
DINEO MABOE | Durban