Executive Summary
Solutionist Thinkers Group was established on the 1st of April 2019, in response to widespread dissatisfaction among Black and Indian healthcare practitioners regarding racial profiling by medical aid schemes and administrators. The organisation represents multidisciplinary health and medical practitioners. The board of directors consist of GP’s, social workers, clinical technologist and psychologists who are hands-on in the fight against racism. This issue has manifested in various illegal and unfair audits that resulted to unfair claw-backs (AOD) by medical aids. The consequences of such treatment left thousands of Black and Indian healthcare practitioners practices closed down, a number of doctors committed suicide, and other medical and healthcare practitioners with mental health illnesses. With a membership of 260 individuals, our organization is dedicated to addressing the discrepancies between Section 59 of the Medical Aid Schemes Act 131 of 1998, medical aid policies, and Chapter 9 of the South African constitution.
We actively seek to collaborate with medical aids to promote social justice and a democratic approach in the design and decision-making processes of medical aid policies. Our goal is to foster inclusivity and ensure a three-tier active participation in shaping these policies. Additionally, Solutionist Thinkers Group focuses on contributing to solutions within the private healthcare sector in South Africa. We firmly believe that addressing economic disparities and dismantling past economic barriers is essential for achieving effective and productive outcomes that benefit all stakeholders involved. Emphasizing a three-tier approach, we aim to minimize any risks or threats to the economic development of the Black and Indian private healthcare sector in South Africa.
Lastly, it is our mandate to liberate healthcare practitioners from any form of discrimination or compromised ethical dilemmas stemming from unjust policies of medical aid schemes. We are committed to advocating for a fair and equitable healthcare system that upholds the rights and dignity of all practitioners.
PROBLEM STATEMENT
Black and Indian healthcare practitioners within our organization are facing significant dissatisfaction due to the utilization of unfair racial profiling instigated by illegal audits and validation processes by medical aids and administrators. Medical aids discrimination targets Black and Indian healthcare practitioners through unfair audits. These audits include using tactics such as manipulating benchmarking procedures to hinder progress and growth, subjecting practitioners to unfairly low codes, labeling progressive practices as outliers, and scrutinizing specific billing codes to impede financial growth of Black and Indica. Regrettably, these discriminatory actions not only harm healthcare providers but also have a detrimental effect on the quality of care that patients receive.
This racial profiling result to unfair claw-backs of funds from service providers, with allegations of fraud, wasteful expenditure, and abuse of tariff codes. Although the substantiated allegations are on a small scale (2%), the impact on Black and Indian practitioners is particularly severe with far reaching consequences. Another challenge is the discriminatory nature of these audits, as Black and Indian practitioners are subjected to different demands for information compared to their White counterparts. This unequal and unfair audit process highlights racial bias within the system.
Furthermore, these audits require the disclosure of confidential information, raising concerns about the ethical conduct of healthcare practitioners and violating the privacy rights of medical aid members. The cumulative effect of these issues compromises the professional integrity of healthcare practitioners and infringes upon the rights and privacy of practitioners and medical aid members. It is imperative to address these challenges to establish a fair and equitable healthcare system that upholds ethical standards, respects diversity, and protects the rights of all individuals involved.
Objectives
Promote Equality and Dignity: Strive to eliminate racial profiling, discrimination, and unfair procedural audits targeting Black and Indian healthcare practitioners, ensuring equal treatment and respect for all practitioners.
Advocacy and Awareness: Collaborate with healthcare associations and other relevant stakeholders to raise awareness about racism and discrimination in the private healthcare system, and to advocate for policy changes and reforms that address these issues.
Section 59 Investigation: Continue supporting and actively engaging in the Section 59 investigation, which aims to uncover and address systemic racism and discriminatory practices within the private healthcare system.
Empowerment and Development: Provide support, resources, and opportunities for professional and financial development to our non-White medical and healthcare practitioners, helping them overcome barriers and achieve their full potential.
Leadership and mentoring: Provide guidance, coaching, and mentoring to the members of Solutionist Thinkers Group. Help them adhere to a good code of ethics, ensure correct coding practices, and minimize fraud, waste, and abuse (FWA) of patients' funds.
Knowledge and training: Provide our members with the necessary knowledge and training to ensure correct coding practices, which plays a vital role in accurate billing and appropriate utilization of healthcare resources. By promoting ethical behavior and correct coding, we actively contribute to minimizing any potential fraud, waste, and abuse of patients' funds, ensuring that healthcare resources are utilized efficiently and for the benefit of the patients we serve.
Patient Access to Quality Healthcare: Work towards ensuring that patients, regardless of their race or ethnicity, have equal access to quality healthcare services, in line with their constitutional rights.
Collaboration and Partnerships: Foster collaborations and partnerships with other organizations, healthcare associations, government agencies, and relevant stakeholders to collectively address the challenges of racism and discrimination in the private healthcare system and achieve our shared goals.
Limitations
Solutionist Thinkers Group needs funding in order to address challenges around billing and the good code of practice.