Inquiry hears medical aid schemes ‘intimidate’ doctors
On Thursday, an organisation which can’t be named to protect its identity, requested to give evidence in camera at the hearing chaired by advocate Tembeka Ngcukaitobi, because it feared being harassed.
The organisation submitted its request saying when it made its intention to give evidence, it started getting harassed by the medical schemes which has put its facilities in “danger”.
After hearing this submission, Ngcukaitobi ruled that the evidence should be given in camera.
Ngcukaitobi, however, warned that this should not set a precedent where all health care professionals (HCP) can request to give evidence in camera as this was a serious national issue which needs to be conducted in public.
One HCP representative who declined to be named after being removed from the venue, said this was how medical aid schemes were now retaliating to frustrate those seen as being vocal. “This is simple in my understanding; you see the whole complaint which was lodged by the medical professionals has led to greater surveillance emanating from the medical aid schemes.
“Remember the medical aid schemes’ justification for selecting doctors, just like what Discovery was doing, was that it was being done randomly but there is no factual evidence to back that up.
“They retaliate, in my understanding by checking who is making the most noise so that they can shut them down as quickly as possible.. you understand?”
He went on to give an analogy of a typical gang fight and said: “If we hit the leader, there are 10 times more chances that others might be scared and not want to participate in the fight at all.”
Similar sentiments were shared by Dr Mvuyiso Talatala of the SA Society of Psychiatrists (Sasop) which represents about 700 members. He said during his submission that the system of forensic investigations by medical schemes was authoritarian, unfair and lacked transparency.
He said the lack of transparency was the hallmark of discriminatory systems.
“Our data shows that there is a racial bias against black and Indian psychiatrists (racism within the design of the system). Total percentage of black, Indian, coloured investigations: 72%, total percentage of white Investigations: 38%,” said Talatala.
He said psychiatry was targeted by the medical schemes when compared to other specialist disciplines. “The process followed by the schemes when investigating, is unethical (stigma/and lack of care).
There is bullying as medical schemes withhold payments if a psychiatrist raises objections about the investigation,” he said.
However, Talatala conceded that there was no denial that fraud may occur in the mental health-care space. He said:
“Sasop respectfully request that the following recommendations be implemented:
“(the) establishment of an independent body to audit psychiatric private practice coding, services and re-organisation of mental health services to be value-based, less hospicentric and with outcome measurements determined and monitored by the practitioners.”
The inquiry continues.