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Medical schemes may have failed to address implicit racial bias, probe hears

Oct 18 2019 14:46
Marelise van der Merwe

While medical schemes under the microscope were apparently "at pains" to avoid any obvious racial profiling in their systems and processes, attempts to be colourblind may have had the unintended effect of making it more difficult to address racial bias.

This is according to Professor Melissa Steyn, chair of SA National Research in Critical Diversity Studies at the University of Witwatersrand, who on Friday gave a presentation to a panel investigating alleged racial profiling by medical aid schemes.

The Council for Medical Schemes, which regulates private health financing through medical aid schemes, announced in May that it had launched a four-month investigation into allegations of racial profiling against black and Indian private medical practitioners by medical aids. 

At the time, the council said medical professionals who were members of the National Health Care Professionals Association alleged they were being treated unjustly. Allegations included racial profiling, blacklisting for payments, blocked payments, demands of confidential clinical information, bullying, harassment, coercion, entrapment and the use of hidden cameras, as Fin24 previously reported.  

Hearings stated in late July. 

Detecting racial bias 

Steyn was asked to appear before the panel, which is chaired by Advocate Tembeka Ngcukaitobi, to discuss whether systems used to detect fraud and abuse in the medical aid sector could also be racially biased.

She said that, in her view, the systems and processes used by medical schemes had attempted to be colourblind and this, while a commendable start, did not address implicit bias.

Citing a United Nations report published earlier this year – the title of which she did not immediately give – Steyn said the medical schemes concerned appeared to have followed many of the UN-recommended "checks and balances". These included creating anonymous databases.

"To me at a level of form it is quite clear companies are at pains to avoid falling into naïve traps around racial profiling. One should assume that this is done sincerely with the intention of doing things correctly," Steyn said.

"This could be seen as an attempt to be rigorously colourblind," she added.

However, she said, "the problem lies more in what is not there than what is there."

"I don't see anything in these procedures that would indicate any deliberate or thoughtful engagement with how to address, identify or eliminate any form of bias that may be implicit within their systems," she said.

Critical race theory assumes that race is a social fact, "always already there in whatever issues we are dealing with in our society," she said, adding that "[i]n South Africa this becomes particularly salient."

"And so to ignore it in our thinking planning and implementation is to be, at best, naïve, but probably indifferent, or even deliberately blind to how different people are affected differently by the same process," she told the panel.

According to Steyn, the ideal, if aiming for equality, would be to aim for "racial cognisance" instead of attempting colourblindness. Colourblindness could, ironically, repress necessary discussion, she explained.

"You can't come out of a system with a history like ours [which is] thoroughly racially inflected […] straight into some kind of race neutral system," she said.

"There has to be some kind of racial cognizance in which you are taking these kinds of issues really seriously."

The investigation continues. The final report was scheduled to be delivered by the investigating panel on November 1, 2019.

private healthcare  |  medical schemes
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